Abstract 18205: Successful Implementation of a Tele-visit Multidisciplinary Program

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ami Bhatt ◽  
Sarah Sossong ◽  
Ada Stefanescu ◽  
Lee H Schwamm
Keyword(s):  
Care Delivery ◽  
Technical Problem ◽  
Healthcare Providers ◽  
Great Majority ◽  
Models Of Care ◽  
Successful Implementation ◽  
Office Visits ◽  
Multidisciplinary Program ◽  
Virtual Visits ◽  
Consumer Assessment

Objectives: To design, implement and assess a patient and physician centered virtual visit program. Methods: Patients within the Cardiology and Neurology departments were enrolled in a real-time videoconferencing virtual visits program between April 1st 2014 and June 3rd 2015. Surveys were sent to patients who had at least one virtual visit between in the first 8 months to assess response to the use of the system and satisfaction, including the Consumer Assessment of Healthcare Providers and Systems survey (CAHPS). Results: There were 131 virtual visits in Cardiology and 419 visits in Neurology. The great majority of patients (83%) responded that they would definitely recommend a virtual visit to family or friends. Patients found the platform easy to use, with 74% of patients easily installing the product. Despite 42.5% reporting at least one technical problem, the overall patient satisfaction was high based on the CAHPS measures (Figure 1), and more than half of patients said they would even be willing to pay an up to $50 copay if needed for such visits. More than half of patients and providers felt that the quality of the visit was the same as in the office. While 45% of Cardiology patients felt the same during a virtual visit as in the office, 45% felt a stronger connection in person. Most providers felt virtual visits were either more efficient (38.5%) or just as long as office visits (50%), while 90% of patients thoughts their clinicians spent just as much time with them. Only 23.2% of patients overall however felt that a telephone call could definitely have addressed the same issue, emphasizing the value of the video conferencing platform. Conclusion: Virtual visits are well received by patients and providers, and considered by both to be efficient and useful. Implementing a virtual visit program with a design approach to assess and respond promptly to user feedback has encouraged adoption and holds promise for increasing the scale and integration into models of care delivery.

scholarly journals Patients and Their Families Weigh in on Evidence-Based Hospital Design

2012 ◽  
Vol 32 (1) ◽  
pp. e1-e10 ◽  
Author(s):  
Kathleen Trochelman ◽  
Nancy Albert ◽  
Jacqueline Spence ◽  
Terri Murray ◽  
Ellen Slifcak
Keyword(s):  
Physical Environment ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Evidence Based ◽  
Institute Of Medicine ◽  
Design Features ◽  
Hospital Design ◽  
Heart Center ◽  
Current Health Care System ◽  
Consumer Assessment

Background In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006. Objective To determine perceptions of patients and their families of evidence-based design features in a new heart center. Methods Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients’ satisfaction with the environment. Results Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed. Conclusions Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients’ safety, satisfaction, and quality of care.

Listening to Patients Changes Clinicians’ Perspectives and Improves Care

2014 ◽  
Vol 20 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Kathleen Vidal
Keyword(s):  
Discharge Planning ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
Family Expectations ◽  
Phone Calls ◽  
Admission Interview ◽  
Hospital Consumer Assessment ◽  
Consumer Assessment

This article shares strategies of an academic medical center and its system of hospitals in partnering with patients and families to create a climate in which patients, families, and clinicians are comfortable enough to ask questions, suggest alternatives, and even choose to disagree. Relationship-Based Care: A Model for Transforming Practice (Koloroutis, 2004) was instrumental in developing an interdisciplinary relationship-based model of care supported by 4 key processes (admission interview, daily rounds, discharge planning, and follow-up phone calls). These processes—along with patient/family councils, patient/family/staff retreats, patient/family representation on hospital committees, and a patient experience bundle—have proven successful in aligning patient and family expectations with clinicians’ care delivery, as reflected in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. A study suggesting the nature of caring as a nurse-driven activity may vary from caring as a patient-driven activity. Inspired engagement with Koloroutis and Trout (2012) See Me as A Person: Creating Therapeutic Relationships with Patients and Their Families; attunement, wondering, following, and holding build bridges between clinicians perceptions and knowledge, and patients knowledge and expectations.

Colorectal cancer survivors’ surveillance patterns and experiences of care: A SEER-CAHPS study.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 229-229
Author(s):  
Michelle A Mollica ◽  
Lindsey Enewold ◽  
Lisa M Lines ◽  
Michael T. Halpern ◽  
Jessica R. Schumacher ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Surgical Resection ◽  
Healthcare Providers ◽  
Ct Imaging ◽  
Fee For Service ◽  
Office Visits ◽  
Specialist Doctor ◽  
Personal Doctor ◽  
History Of ◽  
Consumer Assessment

229 Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer, generally treated with surgical resection, followed by complex surveillance for recurrence. We examined associations between experiences of care and adherence to surveillance Medicare fee-for-service beneficiaries with a history of CRC. Methods: Using linked data from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) cancer registry program, Medicare claims and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience surveys (SEER-CAHPS), we identified survivors ages 65+, diagnosed with local/regional first primary colorectal cancer 1999-2009 who underwent surgical resection and completed CAHPS survey within 36 months of diagnosis. Adherence to guidelines for a three-year observation period was defined as receiving a colonoscopy; at least 2 carcinoembryonic antigen (CEA) tests; and more than 2 office visits and 1 computer tomography (CT) imaging test each year. We dichotomized CAHPS ratings into 9 or 10 out of 10 versus 0-9 for analysis (higher ratings mean better quality). Results: Most of the 314 participants reported ratings of 9 or 10 for overall care (55%), personal doctor (59%), and health plan (60%). Slightly less than half (47%) gave their specialist doctor ratings of 9 or 10. Adherence to surveillance was 76% for office visits, 36.9% for CEA testing, 48.1% for colonoscopy, and 10.3% for CT Imaging. Sixty-two percent of the sample were categorized as adherent (receiving ≥ 2 surveillance guidelines). In multivariable models, adherence to office visits was positively associated with ratings of personal doctor (OR = 2.0; 95% CI = 1.1, 3.5) and specialist doctor (OR = 2.7; 95% CI = 1.4, 4.9), and overall adherence was associated with ratings of personal doctor (OR = 2.1; 95% CI = 1.2, 3.6). Conclusions: Findings point to the important role of patient-provider relationships in adherence to CRC post-resection surveillance guidelines. As adherence to surveillance may increase survival among CRC survivors, further investigation is needed to identify specific components of this relationship, as well as other potential modifiable drivers of surveillance guidelines.

scholarly journals Daily Hand-Off of Chronic Stroke Neurorehabilitation Patients to Expert Clinicians, With Resulting Significant Coordination Improvement: Care Model Development and Implementation

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Jessica McCabe ◽  
Janis Daly ◽  
Michelle Monkiewicz ◽  
Marianne Montana ◽  
Kristi Butler ◽  
...  
Keyword(s):  
Care Delivery ◽  
Model Development ◽  
Models Of Care ◽  
Chronic Stroke ◽  
Successful Implementation ◽  
Model Of Care ◽  
Care Model ◽  
New Model ◽  
Hand Off ◽  
Team Model

Background: New models of care delivery are necessary to meet workforce needs while delivering expert care in neurorehabilitation. Therefore, we sought to develop and assess the implementation of a new model of care for neurorehabilitation using a 5-member team of therapists (5-Team Model) for the treatment of individuals with chronic stroke, rather than a conventional single-therapist model. Methods: A mixed methods approach was employed; continuous quality improvement methods and quasi-experimental pre-test/post-test methods were used to assess the effectiveness of the new model. Six chronic stroke patients participated in an upper limb neurorehabilitation motor learning protocol 5 days/week, 5 hours/day (60 sessions; 300 hours); treatment was administered using the 5-Team Model approach to treatment. Results: Mean improvement on the Fugl Meyer (FM) was 11.5 points. All six participants demonstrated improvement on Fugl Meyer that was within or beyond the minimal clinically important difference (MCID) range of 4.25-7.25 points for chronic stroke. Results indicated that the 5-Team Model was effective in implementing care. Conclusions: The 5-Team Model for neurorehabilitation was successfully implemented, with patient hand-off every day to a different therapist; it produced clinically significant improvement on a measure of coordination (FM) which is comparable to or better than prior reports from a standard care model. This new model of care met the needs of the research team workforce for flexibility, while maintaining the level of quality of care. Successful implementation required addressing a series of hindering factors in an iterative manner and enhancing promoting factors. These elements included the context within which the change was implemented, the methods used in implementing the change, the evidence that the change was successful, and communication that the change was successful. The context requirements included existing framework and participating model members who were willing to exert the required effort for success, model champions. This high level of enthusiastic participation along with strong leadership contributed to long-term success, sustainability.

A Qualitative Examination of User Perceptions of User-Driven and App-Controlled Hearing Technologies

2019 ◽  
Vol 28 (4) ◽  
pp. 993-1005 ◽  
Author(s):  
Gitte Keidser ◽  
Nicole Matthews ◽  
Elizabeth Convery
Keyword(s):  
Hearing Aids ◽  
Care Delivery ◽  
Hearing Aid ◽  
New Technology ◽  
Successful Implementation ◽  
Semistructured Interview ◽  
User Perceptions ◽  
Template Analysis ◽  
Training And Support ◽  
And Training

Purpose The aim of this study was to examine how hearing aid candidates perceive user-driven and app-controlled hearing aids and the effect these concepts have on traditional hearing health care delivery. Method Eleven adults (3 women, 8 men), recruited among 60 participants who had completed a research study evaluating an app-controlled, self-fitting hearing aid for 12 weeks, participated in a semistructured interview. Participants were over 55 years of age and had varied experience with hearing aids and smartphones. A template analysis was applied to data. Results Five themes emerged from the interviews: (a) prerequisites to the successful implementation of user-driven and app-controlled technologies, (b) benefits and advantages of user-driven and app-controlled technologies, (c) barriers to the acceptance and use of user-driven and app-controlled technologies, (d) beliefs that age is a significant factor in how well people will adopt new technology, and (e) consequences that flow from the adoption of user-driven and app-controlled technologies. Specifically, suggested benefits of the technology included fostering empowerment and providing cheaper and more discrete options, while challenges included lack of technological self-efficacy among older adults. Training and support were emphasized as necessary for successful adaptation and were suggested to be a focus of audiologic services in the future. Conclusion User perceptions of user-driven and app-controlled hearing technologies challenge the audiologic profession to provide adequate support and training for use of the technology and manufacturers to make the technology more accessible to older people.

scholarly journals Impact of the COVID-19 pandemic: a perspective from industry

2020 ◽  
Vol 22 (Supplement_P) ◽  
pp. P56-P59
Author(s):  
Nick E J West ◽  
Wai-Fung Cheong ◽  
Els Boone ◽  
Neil E Moat
Keyword(s):  
Care Delivery ◽  
Models Of Care ◽  
Medium Term ◽  
Change Models ◽  
New Device ◽  
Supply Chain Logistics ◽  
Cardiovascular Patients ◽  
Medical Crisis ◽  
Device Industry

Abstract The global COVID-19 pandemic has led to unprecedented change throughout society.1 As the articles in this supplement outline, all segments of the broader cardiovascular community have been forced to adapt, to change models of care delivery, and to evolve and innovate in order to deliver optimal management for cardiovascular patients. The medtech/device industry has not been exempt from such change and has been forced to navigate direct and indirect COVID-associated disruption, with effects felt from supply chain logistics to the entire product lifecycle, from the running of clinical trials to new device approvals and managing training, proctoring and congresses in an increasingly-online world. This sea-change in circumstances itself has enforced the industry, in effect, to disrupt its own processes, models and activities. Whilst some of these changes may be temporary, many will endure for some time and some will doubtless become permanent; one thing is for sure: the healthcare ecosystem, including the medical device industry, will never look quite the same again. Although the pandemic has brought a short- to medium-term medical crisis to many countries, its role as a powerful disruptor cannot be underestimated, and may indeed prove to be a force for long-term good, given the accelerated innovation and rapid adaptation that it has cultivated.

scholarly journals Physician requirements for adoption of telehealth following the SARS-CoV-2 pandemic

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Michael Hodgkins ◽  
Meg Barron ◽  
Shireesha Jevaji ◽  
Stacy Lloyd
Keyword(s):  
Care Delivery ◽  
Virtual Technology ◽  
Privacy Concerns ◽  
Face To Face ◽  
House Calls ◽  
Care Delivery Model ◽  
Virtual Visits ◽  
Similar Survey ◽  
Remote Care

AbstractIt took the advent of SARS-CoV-2, a “black swan event”, to widely introduce telehealth, remote care, and virtual house calls. Prior to the epidemic (2019), the American Medical Association (AMA) conducted a routine study to compare physicians’ adoption of emerging technologies to a similar survey in 2016. Most notable was a doubling in the adoption of telehealth/virtual technology to 28% and increases in the use of remote monitoring and management for improved care (13–22%). These results may now seem insignificant when compared to the unprecedented surge in telehealth visits because of SARS-CoV-2. Even as this surge levels off and begins to decline, many observers believe we will continue to see a persistent increase in the use of virtual visits compared to face-to-face care. The requirements for adoption communicated by physicians in both the 2016 and 2019 surveys are now more relevant than ever: Is remote care as effective as in-person care and how best to determine when to use these modalities? How do I safeguard my patients and my practice from liability and privacy concerns? How do I optimize using these technologies in my practice and, especially integration with my EHR and workflows to improve efficiency? And how will a mix of virtual and in-person visits affect practice revenue and sustainability? Consumers have also expressed concerns about payment for virtual visits as well as privacy and quality of care. If telehealth and remote care are here to stay, continuing to track their impact during the current public health emergency is critically important to address so that policymakers and insurers will take necessary steps to ensure that the “new normal” will reflect a health care delivery model that can provide comparable or improved results today and into the future.

scholarly journals Developing implementation strategies to adopt Enhanced Recovery After Surgery (ERAS®) guidelines

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Jennifer Y Lam ◽  
Alexandra Howlett ◽  
Duncan McLuckie ◽  
Lori M Stephen ◽  
Scott D N Else ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Healthcare Providers ◽  
Implementation Strategies ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Care Pathways ◽  
Audit System ◽  
Local Contexts

Abstract Background Strong implementation strategies are critical to the success of Enhanced Recovery after Surgery (ERAS®) guidelines, though little documentation exists on effective strategies, especially in complex clinical situations and unfamiliar contexts. This study outlines the process taken to adopt a novel neonatal ERAS® guideline. Methods The implementation strategy was approached in a multi-pronged, concurrent but asynchronous fashion. Between September 2019 and January 2020, healthcare providers from various disciplines and different specialties as well as parents participated in the strategy. Multidisciplinary teams were created to consider existing literature and local contexts including potential facilitators and/or barriers. Task forces worked collaboratively to develop new care pathways. An audit system was developed to record outcomes and elicit feedback for revision. Results 32 healthcare providers representing 9 disciplines and 5 specialties as well as 8 parents participated. Care pathways and resources were created. Elements recommended for a successful implementation strategy included identification of champions, multidisciplinary stakeholder involvement, consideration of local contexts and insights, patient/family engagement, education, and creation of an audit system. Conclusion A multidisciplinary and structured process following principles of implementation science was used to develop an effective implementation strategy for initiating ERAS® guidelines.

scholarly journals Evaluation of Patient Experience During Virtual and In-Person Urgent Care Visits: Time and Cost Analysis

2021 ◽  
Vol 8 ◽  
pp. 237437352098148
Author(s):  
Saif Khairat ◽  
Xi Lin ◽  
Songzi Liu ◽  
Zhaohui Man ◽  
Tanzila Zaman ◽  
...  
Keyword(s):  
Patient Experience ◽  
Care Delivery ◽  
Turnaround Time ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Cross Sectional ◽  
Significant Difference ◽  
Virtual Visits ◽  
One Year

Urgent care (UC) is one of the fastest growing venues of health care delivery for nonemergent conditions. This study compared the patient experience during virtual and in-person urgent care visits. We conducted a cross-sectional study of patients with the same diagnosis during Virtual Urgent Care (VUC) and in-person UC visits with the same diagnosis with regard to time and cost over a period of one year. We recorded and analyzed 16 685 urgent care visits: In-person UC (n = 14 734), VUC (n = 1262). Significant differences were found in the average total time for a visit in an in-person UC (70.89 minutes), and VUC (9.38 minutes). The average total cost of VUC ($49) and in-person UC ($142.657) differed significantly. Significant difference was found between UC turnaround time and VC turnaround time (Dependent variable (DV): 53.77, P < .01). We found significant differences in cost and time between in favor of virtual visits. Our findings suggest additional policy reform to expand the use of virtual care among target populations to improve access, reduce costs, meet the needs of patients, and reduce emergency department visits.

scholarly journals Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042547
Author(s):  
Atif Riaz ◽  
Olga Cambaco ◽  
Laura Elizabeth Ellington ◽  
Jennifer L Lenahan ◽  
Khatia Munguambe ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Low Income ◽  
Lung Ultrasound ◽  
New Technology ◽  
Healthcare Providers ◽  
Ease Of Use ◽  
Local Context ◽  
Future Research ◽  
Successful Implementation ◽  
Pneumonia Diagnosis

ObjectivesPaediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia.DesignProspective qualitative study using semistructured interviewsSettingTwo referral hospitals in Mozambique and PakistanParticipantsA total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled.ResultsHCPs highlighted themes of limited resource availability for the feasibility of LUS implementation, including perceived high cost of equipment, maintenance demands, time constraints and limited trained staff. HCPs emphasised the importance of policymaker support and caregiver acceptance for long-term success. HCP perspectives of usability highlighted ease of use and integration into existing workflow. HCPs and caregivers had positive attitudes towards LUS with few exceptions. Both HCPs and caregivers emphasised the potential for rapid, improved diagnosis of paediatric respiratory conditions using LUS.ConclusionsThis was the first study to evaluate HCP and caregiver perspectives of paediatric LUS through qualitative analysis. Critical components impacting feasibility, usability and acceptability of LUS for paediatric pneumonia diagnosis in LMIC were identified for initial deployment. Future research should explore LUS sustainability, with a particular focus on quality control, device maintenance and functionality and adoption of the new technology within the health system. This study highlights the need to engage both users and recipients of new technology early in order to adapt future interventions to the local context for successful implementation.Trial registration numberNCT03187067.

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