Abstract 13727: Mapping Analysis Clarifies the Correlation Between Distribution of Patient’s Home Address and Participation in Outpatient Cardiac Rehabilitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Atsuko Nakayama ◽  
Masatoshi Nagayama ◽  
Hiroyuki Morita ◽  
Issei Komuro ◽  
Mitsuaki Isobe
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Cardiac Rehabilitation ◽  
Medical Decision Making ◽  
Participation Rate ◽  
Medical Decision ◽  
Geographical Analysis ◽  
Patients With Heart Failure ◽  
The Impact ◽  
Road Distance

Introduction: Geographical analysis is developing as a powerful tool for evaluating the quality of medical service and acquiring the fundamental data for medical decision-making. Using a geographical analysis, we can evaluate the impact of the distance from patient’s home to the hospital on the participation in outpatient cardiac rehabilitation (CR). Methods: All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure and aortic diseases were recommended to participate in outpatient-CR program after discharge. In the dataset of prospective cohort study of CR from 2004 to 2015 (n=9,019), we investigated the impact of the distance from patient’s home to hospital on the participation in outpatient-CR program using the geographical analysis. Results: The total participation rate of outpatient-CR was 47% in our study population. The participation rate of outpatient-CR was highest (62%) in patients with road distance from home to hospital < 10 km as compared with those with road distance of 10-20 km, 20-30 km and >30km to hospital (51%, 39%, and 23%, respectively, p<0.001). Patients whose road distance from home to hospital was < 30 km more participated in outpatient-CR as compared with patients whose road distance was ≧30 km (Odds ratio 4.41, 95%CI 3.86 - 5.04). Expecially in patients with heart failure, the longer distance-the less participation rate relationship was menifest (p<0.01). Conclusions: Using the geographical analysis, we could successfully evaluate the impact of road distance from patient’s home to hospital on the participation in outpatient-CR after discharge in patients with cardiovascular diseases. Especially in patients with heart failure, “the longer distance, the less participation” relationship was manifest. This geographical analysis will provide us with essential information for future epidemiological and clinical studies as well as medical decision-making, improving the healthcare service.

scholarly journals The use of geographical analysis in assessing the impact of patients’ home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Atsuko Nakayama ◽  
Masatoshi Nagayama ◽  
Hiroyuki Morita ◽  
Takuya Kawahara ◽  
Issei Komuro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Medical Decision ◽  
Aortic Diseases ◽  
Geographical Analysis ◽  
Valvular Surgery ◽  
The Impact ◽  
Road Distance

Abstract Purpose Geographical analysis is becoming a powerful tool for evaluating the quality of medical services and acquiring fundamental data for medical decision-making. Using geographical analysis, we evaluated the impact of the distance from patients’ homes to the hospital on their participation in outpatient cardiac rehabilitation (OCR). Methods All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure, and aortic diseases were advised to participate in an OCR program after discharge. Using the dataset of our cohort study of OCR from 2004 to 2015 (n = 9,019), we used geographical analysis to investigate the impact of the distance from patients’ homes to hospital on their participation in our OCR program. Results Patients whose road distance from home to hospital was 0–10 km, 10–20 km, and 20–30 km participated more in OCR than those whose road distance was ≧ 30 km (OR 4.34, 95% CI 3.80–4.96; OR 2.98, 95% CI 2.61–3.40; and OR 1.90, 95% CI 1.61–2.23, respectively). Especially in patients with heart failure, the longer the distance, the lesser the participation rate (P < .001). Conclusions Using geographical analysis, we successfully evaluated the factors influencing patients’ participation in OCR. This illustrates the importance of using geographical analysis in future epidemiological and clinical studies. Trial registration UMIN000028435.

scholarly journals Medical decision making among patients with heart failure – does migration background matter?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Olaf von dem Knesebeck ◽  
Martin Scherer ◽  
Gabriella Marx ◽  
Sarah Koens
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Migration Background ◽  
Disease Stage ◽  
Medical Decision ◽  
Diagnosis And Management ◽  
Migration History

Abstract Background Some studies, mainly coming from the U.S., indicate disparities in heart failure (HF) treatment according to migration/ethnicity. However, respective results are inconsistent and cannot be transferred to other health care systems. Thus, we will address the following research question: Are there differences in the diagnosis and management of HF between patients with and without a Turkish migration background in Germany? Methods A factorial experimental design with video vignettes was applied. In the filmed simulated initial encounters, professional actors played patients, who consulted a primary care physician because of typical HF symptoms. While the dialog was identical in all videos, patients differed in terms of Turkish migration history (no/yes), sex (male/female), and age (55 years/75 years). After viewing the video, primary care physicians (N = 128) were asked standardized and open ended questions concerning their decisions on diagnosis and therapy. Results Analyses revealed no statistically significant differences (p < 0.05), but a consistent tendency: Primary care doctors more often asked lifestyle and psychosocial questions, they more often diagnosed HF, they gave more advice to rest and how to behave in case of deterioration, they more often auscultated the lung, and more often referred to a specialist when the patient has a Turkish migration history compared to a non-migrant patient. Differences in the medical decisions between the two groups ranged between 1.6 and 15.8%. In 10 out of 12 comparisons, differences were below 10%. Conclusions Our results indicate that are no significant inequalities in diagnosis and management of HF according to a Turkish migration background in Germany. Primary care physicians’ behaviour and medical decision making do not seem to be influenced by the migration background of the patients. Future studies are needed to verify this result and to address inequalities in HF therapy in an advanced disease stage.

The impact of “significant others” on breast cancer patients’ treatment decision making.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 20-20
Author(s):  
Suepattra G. May ◽  
Katharine Rendle ◽  
Meghan Halley ◽  
Nicole Ventre ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Medical Decision Making ◽  
Treatment Decision ◽  
Significant Others ◽  
Medical Decision ◽  
Breast Cancer Patients ◽  
Treatment Decision Making ◽  
The Impact

20 Background: Shared medical decision making (SDM) has been lauded by advocates for its potential to democratize the patient-physician relationship. However, the practice of SDM is still conceived of as largely a dyadic moment that exists between the patient and the physician. Few studies have looked at the role of significant others (spouses, partners, family members and friends) in decision making or considered how discussions and actions outside the consultation room affect a patient’s medical decisions. This prospective study investigated the impact of significant others on the decision making deliberations of newly diagnosed breast cancer patients. Methods: Forty-one newly diagnosed breast cancer patients were interviewed at four critical time points throughout treatment to explore how they deliberated decisions with both care providers and significant others. Surveys assessing HRQOL, role preferences and treatment satisfaction along with EHR abstraction augmented interview data. Grounded theory analysis was used to identify recurrent themes in the qualitative data, and survey data were analyzed using IBM SPSS Statistics 20. Results: Emergent themes from our analysis identified several factors that patients consider when faced with cancer treatment decisions, including 1) presentation of treatment options 2) patient or significant other conflict/concordance with care team recommendations 3) perceived risk of recurrence and 4) short and long term impact of treatment on daily life. Participants stressed the need for clinicians to view patients beyond diagnosis and recognize their larger care network as influential factors in their decision making. Conclusions: Our interviews highlight how the current healthcare delivery structure rarely acknowledges the circles of care that can exert influence on decision making. Lack of attention to non-clinical others can lead to sub-optimal medical decision making because these influences are not adequately understood by clinicians. Findings from this study suggest the need to enhance clinicians’ and researchers’ understanding of the influence of others in patients’ treatment decision making, enabling them to intervene in these practices.

scholarly journals Medical Decision Making among Adolescents and Young Adults with Heart Failure

2021 ◽  
Vol 40 (4) ◽  
pp. S238-S239
Author(s):  
M. Cousino ◽  
V. Miller ◽  
C. Smith ◽  
H. Lim ◽  
S. Yu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Young Adults ◽  
Medical Decision Making ◽  
Adolescents And Young Adults ◽  
Medical Decision

scholarly journals Associations between kidney function and outcomes following cardiac rehabilitation in patients with heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Hamazaki ◽  
K Kamiya ◽  
K Nozaki ◽  
T Ichikawa ◽  
M Yamashita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Physical Function ◽  
Hospital Discharge ◽  
Kidney Function ◽  
Exercise Intolerance ◽  
Kidney Dysfunction ◽  
Clinical Events ◽  
Patients With Heart Failure ◽  
The Impact

Abstract Background Kidney dysfunction is considered one of the most prevalent comorbidities in patients with heart failure (HF). A combination of HF and kidney dysfunction is associated with peripheral muscle impairment, exercise intolerance, and poor prognosis. Conversely, cardiac rehabilitation (CR) for HF patients has been recognized to improve their clinical outcomes. However, the impact of kidney function on responses to CR in patients with HF is still unclear. Purpose This study aimed to investigate the associations between baseline kidney function and outcomes following CR including changes in physical function and prognosis in HF patients. Methods We reviewed a total of 3,727 patients who were admitted for HF treatment and underwent comprehensive CR during hospitalization. In addition to clinical characteristics, we assessed the kidney function using estimated glomerular filtration rate (eGFR) based on serum creatinine level at hospital discharge as baseline. The quadriceps strength (QS) and 6-minute walk distance (6MWD) were measured as muscle strength and functional capacity, respectively, at baseline. We also remeasured these parameter 5 months after hospital discharge in patients who participated in outpatient CR. The association between participation in outpatient CR and composite outcome of all-cause death and/or unplanned readmission were assessed using the multivariate Cox proportional hazard models in a subgroup of baseline eGFR. We also compared the changes in QS and 6MWD (ΔQS and Δ6MWD) between the eGFR stages. Results During the median follow-up period of 1.9 years, all-cause death/readmission occurred in 1604 (43.0%) patients, and their rate of incidence was 20.9/100 person-years. Out of studied patients, 1,585 (42.5%) patients participated in outpatient CR that was significantly associated with lower incidences of all-cause clinical events in patients with both eGFR ≥60 (adjusted hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.60–0.89, P=0.002) and eGFR &lt;60 (adjusted HR: 0.88, 95% CI: 0.78–0.99, P=0.045), but those with an eGFR &lt;60 showed significant interaction between CR participation and adverse clinical events (interaction P&lt;0.035, Figure 1). Among the outpatient CR participants, QS and 6MWD were significantly higher after 5-month CR than those at baseline (P&lt;0.001, respectively), but the low baseline eGFR correlated with low ΔQS and Δ6MWD (trend P&lt;0.001, respectively) even after adjustment for clinical confounding factors (Figure 2). Conclusions Although the outcomes following CR is affected by baseline kidney function, outpatient CR is significantly associated with the positive change in physical function and better prognosis in HF patients with low kidney function. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The Impact of Pet Care Needs on Medical Decision-Making among Hospitalized Patients: A Cross-Sectional Analysis of Patient Experience

2021 ◽  
Vol 8 ◽  
pp. 237437352110460
Author(s):  
Carri S. Polick ◽  
Jennifer W. Applebaum ◽  
Caitlin Hanna ◽  
Darnysus Jackson ◽  
Sophia Tsaras-Schumacher ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Negative Impact ◽  
Care Center ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
Medical Decision ◽  
Care Needs ◽  
Cross Sectional ◽  
The Impact

Hospital-based protocols to support pet care needs for hospitalized patients may have potential to benefit patient health and wellbeing, but must be informed by experiences of hospitalized pet owners. The aim of this study was to determine the scope and need for pet care services among hospitalized patients. A panel of prior inpatients and their family members at a tertiary care center were surveyed about preferences, experiences, and need for assistance with pet care during hospitalization. Respondents (n = 113) expressed interest in a low/no-cost pet-boarding or foster program for adult patients struggling to find pet care assistance. The majority of respondents (n = 71; 63%) reported challenges securing pet care during a prior hospitalization, and/or knew someone who encountered similar challenges. Respondents also indicated that these challenges had a negative impact on health, recovery, or their own decision to receive medical care. Pet care challenges during hospitalization are likely common and have the potential to hamper medical decision-making and health outcomes of inpatients.

Sign in / Sign up

Export Citation Format

Share Document