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.

Abstract P279: Using Systems Redesign to Develop, Implement, and Evaluate the Effectiveness of a Care Transitions and Hypertension Management Program for Veterans With Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Laura Burrone ◽  
Manali Phadke ◽  
Jan-Michael Ragunton ◽  
Paul Hurd ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Care Coordination ◽  
Clinical Pharmacy ◽  
Care Transitions ◽  
Management Program ◽  
Healthcare Personnel ◽  
Categorical Variables ◽  
Hypertension Management ◽  
Post Discharge ◽  
Post Stroke

Introduction: Patients are routinely discharged after an ischemic stroke with uncontrolled hypertension; blood pressure (BP) at discharge predicts BP 6-months post-discharge. Hypothesis: Systems Redesign approaches can develop and implement effective interventions using existing infrastructure more efficiently to improve care transitions and hypertension management for Veterans 6-months post-stroke. Methods: Two external facilitators with expertise in clinical stroke care and Systems Redesign conducted a rapid process improvement workshop with local healthcare personnel and hospital leadership within a large VA medical center providing suboptimal post-stroke BP control. The team process mapped out the current state of BP control post-stroke and conceptualized a future state with enhanced care coordination between inpatient and outpatient providers and increased engagement of underutilized talent within clinical pharmacy and telehealth. The CAre Transitions and Hypertension (CATcH) management program was created and implemented. Chart review was conducted to collect data related to BP and healthcare utilization. Categorical variables were examined by calculating frequency distributions and using chi-square or fisher’s exact tests. Results: A total of 76 Veterans were the recipient of the CATcH program. Compared to Veterans admitted in the 6-months prior to program implementation, utilization of clinical pharmacy (68.4% versus 33.3%; P =0.0002) and telehealth services (48.7% versus 4.2%; P <0.0001). CATcH patients were also more likely to return home/home with services than historical controls (86.6% versus 60.4%; P =0.003). Mean (SD) systolic BP reduction from discharge to 6-month follow-up these CATcH patients was 8.9 (5.3) mmHg. Rates of readmission to the hospital and presenting to the emergency room within the 6-months post-discharge period were not significantly different between groups. Conclusions: Systems Redesign could be used retool existing workflow and enhance care coordination and collaboration. Improving processes related to care transitions and post-stroke hypertension management increased the likelihood of returning to home/home with services and BP control for stroke survivors.

scholarly journals Care transition to skilled nursing facility – A model and a case study

2019 ◽  
Vol 8 (3) ◽  
pp. 38 ◽  
Author(s):  
Mohan Tanniru ◽  
Jacqueline Jones ◽  
Samer Kazziha ◽  
Michelle Hornberger
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Skilled Nursing Facility ◽  
Care Quality ◽  
Care Transition ◽  
Care Providers ◽  
Post Discharge ◽  
Nursing Facility ◽  
Skilled Nursing

Background: Healthcare providers have focused on improving patient care transitions to reduce unanticipated readmission costs, improve patient care quality post-discharge and increase patient satisfaction. This is especially true in US since the introduction of the Affordable Care Act. While there are several practices and evidence-based programs discussed in the literature to address care transition post-discharge, the key challenge remains the same – how to structure the care transition program to influence its effectiveness. In this paper, we focus on modeling one particular care transition – moving a patient from a hospital to a skilled nursing facility (SNF) – and discuss how improved capacity building and use of intermediaries such as advanced nurse practitioners have shown promise in reducing patient readmissions.Method: The methodology proposed here uses service dominant (SD) logic research to inductively derive a model for service exchanges between the two provider ecosystems. This model is then used to analyze service gaps and look for opportunities to innovate within an SNF and improve its capacity to deliver care. Use of intermediation that expands the service model with the addition of more care providers besides the hospital and SNF is also discussed to reduce patient readmissions.   Results: The study demonstrates that a number of actors have to work collaboratively to make care transition effective in meeting the patient and provider goals. Specifically, when two care facilities, hospital and SNF, are involved in care transition, opportunities exist to improve their internal capacity to address care within and across facilities.    Conclusion: The paper makes two important contributions. It shows the role of SD Logic in identifying opportunities for service innovations in support of care transition, and it shows the role of actors in provider-customer ecosystems to make the transition effective.    

scholarly journals Family Caregivers on the Frontline: Challenges of Providing Care to Post-ICU COVID-19 Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 946-946
Author(s):  
Amanda Leggett ◽  
Alicia Carmichael ◽  
Natalie Leonard ◽  
Sheria Robinson-Lane ◽  
Sophia Li ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Qualitative Interviews ◽  
Critical Role ◽  
Contact Fatigue ◽  
Well Being ◽  
Care Providers ◽  
Care Needs ◽  
Post Discharge ◽  
Discharge Care ◽  
Knowledge Deficits

Abstract Family caregivers are essential care providers helping to ensure the sometimes complicated recovery of recently hospitalized COVID-19 patients. COVID-19 caregivers face pandemic-specific challenges such as not being at patient bedside throughout the hospital stay and managing social distancing post-discharge. The current study aims to explore the unique experiences of family caregivers of Intensive Care Unit (ICU) COVID-19 patients. In-depth qualitative interviews were conducted by web conference with 13 dyads of adults who were in an ICU for COVID-19 between March and August 2020 and their primary caregiver (n=26). Participants were interviewed about the care recipient’s hospitalization and recovery journey, supports received, challenges experienced, and gaps in the system of care. Thematic qualitative analysis was conducted utilizing Watkins’ (2017) rigorous and accelerated data reduction (RADaR) technique. Caregivers played a critical role in patient admission, discharge, and recovery. Themes of caregiving challenges included self-management of COVID-19 infection, knowledge deficits of available resources and post-discharge care needs, post-infection stigma, separation guilt, deprioritized self-care, financial challenges, and lengthy recoveries with some ongoing health needs. While receipt of emotional support was considered an advantage, some caregivers expressed contact fatigue. Understanding how COVID caregivers experience illness management across the recovery journey can aid our understanding of the COVID caregiving process and identify intervention targets to improve overall health and well-being of the care dyad.

scholarly journals Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers

2015 ◽  
Vol 23 (e1) ◽  
pp. e146-e151 ◽  
Author(s):  
Genna R Cohen ◽  
Julia Adler-Milstein
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Care Coordination ◽  
Care Transitions ◽  
Meaningful Use ◽  
Primary Care Providers ◽  
Care Providers ◽  
Organizational Strategies ◽  
Primary Care Practices ◽  
Stage 1

Abstract Background Stage 2 and proposed Stage 3 meaningful use criteria ask providers to support patient care coordination by electronically generating, exchanging, and reconciling key information during patient care transitions. Methods A stratified random sample of primary care practices in Michigan ( n  = 328) that had already met Stage 1 meaningful use criteria was surveyed, in order to identify the anticipated barriers to meeting these criteria as well as the expected impact on patient care coordination from doing so. Results The top three barriers, as identified by &gt;65% of the primary care providers surveyed, were difficulty sending and receiving patient information electronically, a lack of provider and practice staff time, and the complex workflow changes required. Despite these barriers, primary care providers expressed strong agreement that meeting the proposed Stage 3 care coordination criteria would improve their patients’ treatment and ensure they know about their patients’ visits to other providers. Conclusion The survey results suggest the need to enhance policy approaches and organizational strategies to address the key barriers identified by providers and practices in order to realize important care coordination benefits.

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.

Strategi Pengembangan Instalasi Farmasi Rsud Sosodoro Djatikoesoemo Bojonegoro dengan Metode SWOT

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Youstiana Dwi Rosita
Keyword(s):  
Development Strategy ◽  
Health Care Providers ◽  
Clinical Pharmacy ◽  
Swot Analysis ◽  
Care Providers ◽  
Qualitative Descriptive ◽  
Study Population ◽  
Strategy Planning ◽  
The Government

ABSTRAK Rumah sakit adalah institusi penyedia jasa layanan kesehatan, Rumah Sakit Umum Daerah Dr. R. Sosodoro Djatikoesoemo Bojonegoro sebagai salah satu Rumah Sakit milik pemerintah kabupaten Bojonegoro. Sebagai pusat rujukandari beberapa rumah sakit di daerah Bojonegoro dan sekitarnya. Dalam penelitian ini menggunkan suatu pen dekatan dengan analisis SWOT yang merupakan langkah awal dari suatu perencanaan strategi pengembangan yang dimulai dengan identifikasi masalah, tujuan organisasi sampai pada menimbang kekuatan dan kelemahan sendiri serta peluang dan ancaman dari luar dan juga melakukan beberapa langkah penting yang menunjang pemasaran atau pengembangan. Jenis penelitian ini adalah penelitian studi kasus dengan menggunakan rancangan penelitian deskriptif kualitatif dan Populasi dalam penelitian ini populasinya adalah pasien rawatinap dan pasien rawat jalan sebanyak 200 orang responden Sampel merupakan sebagian atau wakil populasi yang diteliti. Dalam penelitian ini mengunakan sampling pertimbangan (Judgement Sampling) Dari hasil pendekatan dengan analisis SWOT perlunya pelaksanaan atau realisasi dari struktur organisasi yang menempatkan farmasis dalam farmasi klinik, peningkatan kualitas dan kuantitas sumber daya manusia, serta perlunya penambahan fasilitas berhubungan dengan IPTEK untuk kegiatan pelayanan farmasi baik secara manajerial maupun ke arah farmasi klinik. Kata Kunci : Farmasi, Analisis SWOT ABSTRACT The hospital is an institution health care providers, Regional General Hospital Dr. R. Sosodoro Djatikoesoemo Bojonegoro as one of the government-owned hospital Bojonegoro. As the center rujukandari several hospitals in Bojonegoro and the surrounding area. In this study using the approach with a pen SWOT analysis is the first step of a development strategy planning which starts with the identification of the problem, the purpose of the organization came to weigh their own strengths and weaknesses, opportunities and threats from the outside and also did some important steps to support the marketing or development. This research is a case study using qualitative descriptive study design and population in this study population was rawatinap patients and outpatients as many as 200 people respondent sample is partially or representative of the population studied. In this study, using sampling considerations (Judgement Sampling) From the SWOT analysis approach with the need for the implementation or realization of the organizational structure that puts pharmacists in clinical pharmacy, improving the quality and quantity of human resources, as well as the need for additional facilities related to science and technology for good pharmaceutical service activities managerially and in the direction of clinical pharmacy. Key Words : Pharmacy, SWOT Analysis

scholarly journals Feasibility and Assessment of a Cascade Traceback Screening Program (FACTS): Protocol for a Multisite Study to Implement and Assess an Ovarian Cancer Traceback Cascade Testing Program

2021 ◽  
Vol 11 (6) ◽  
pp. 543
Author(s):  
Anna DiNucci ◽  
Nora B. Henrikson ◽  
M. Cabell Jonas ◽  
Sundeep Basra ◽  
Paula Blasi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Health Care Providers ◽  
Screening Program ◽  
Qualitative Interviews ◽  
Care Providers ◽  
Genetic Privacy ◽  
Program Outcomes ◽  
Cascade Testing ◽  
Program Costs

Ovarian cancer (OVCA) patients may carry genes conferring cancer risk to biological family; however, fewer than one-quarter of patients receive genetic testing. “Traceback” cascade testing —outreach to potential probands and relatives—is a possible solution. This paper outlines a funded study (U01 CA240747-01A1) seeking to determine a Traceback program’s feasibility, acceptability, effectiveness, and costs. This is a multisite prospective observational feasibility study across three integrated health systems. Informed by the Conceptual Model for Implementation Research, we will outline, implement, and evaluate the outcomes of an OVCA Traceback program. We will use standard legal research methodology to review genetic privacy statutes; engage key stakeholders in qualitative interviews to design communication strategies; employ descriptive statistics and regression analyses to evaluate the site differences in genetic testing and the OVCA Traceback testing; and assess program outcomes at the proband, family member, provider, system, and population levels. This study aims to determine a Traceback program’s feasibility and acceptability in a real-world context. It will account for the myriad factors affecting implementation, including legal issues, organizational- and individual-level barriers and facilitators, communication issues, and program costs. Project results will inform how health care providers and systems can develop effective, practical, and sustainable Traceback programs.

scholarly journals The Role of Rehabilitation in Reducing Resource Use and Lowering Hospital Readmission Through Discharge Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 804-804
Author(s):  
Kenneth Miller
Keyword(s):  
Health Care Providers ◽  
Resource Use ◽  
Hospital Readmission ◽  
Discharge Planning ◽  
Care Transitions ◽  
Healthcare Team ◽  
Transition Management ◽  
Care Providers ◽  
Initial Examination ◽  
The Individual

Abstract The transitions between medical settings, the community and back again is a complex and intimidating process for patients, families and caregivers. These transitions are vulnerable points where planning is key and must begin at the initial examination with rehabilitation providers (PTs/OTs,SLPs). These providers are key members of the healthcare team to facilitate effective transition management. In this session, attendees will learn the critical factors rehabilitation providers use to evaluate patients in order to facilitate successful care transitions. An overview of the indications for rehabilitation referral will be presented, as well as evidence for effective rehabilitation strategies. The speaker will present tools from the American Physical Therapy Association Home Health Toolbox and outline a decision-making process for care transitions based on the individual, caregivers, and health care providers to achieve successful transitions that reduce resource use and hospital readmission rates. Attendees will learn strategies to facilitate inter-professional collaboration, communication, and advocacy.

scholarly journals Improving the quality of child-care centres through supportive assessment and ‘communities of practice’ in informal settlements in Nairobi: protocol of a feasibility study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042544
Author(s):  
Margaret Nampijja ◽  
Kenneth Okelo ◽  
Patricia Kitsao Wekulo ◽  
Elizabeth W Kimani-Murage ◽  
Helen Elsey
Keyword(s):  
Child Care ◽  
Qualitative Interviews ◽  
Informal Settlements ◽  
Poor Quality ◽  
Assessment Process ◽  
Child Care Providers ◽  
Care Providers ◽  
Policy And Practice ◽  
Child Care Centre ◽  
Scientific Review

IntroductionInvesting in children during the critical period between birth and age 5 years can have long-lasting benefits throughout their life. Children in Kenya’s urban informal settlements, face significant challenges to healthy development, particularly when their families need to earn a daily wage and cannot care for them during the day. In response, informal and poor quality child-care centres with untrained caregivers have proliferated. We aim to co-design and test the feasibility of a supportive assessment and skills-building for child-care centre providers.Methods and analysisA sequential mixed-methods approach will be used. We will map and profile child-care centres in two informal settlements in Nairobi, and complete a brief quality assessment of 50 child-care centres. We will test the feasibility of a supportive assessment skills-building system on 40 child-care centres, beginning with assessing centre-caregivers’ knowledge and skills in these centres. This will inform the subsequent co-design process and provide baseline data. Following a policy review, we will use experience-based co-design to develop the supportive assessment process. This will include qualitative interviews with policymakers (n=15), focus groups with parents (n=4 focus group discussions (FGDs)), child-care providers (n=4 FGDs) and joint workshops. To assess feasibility and acceptability, we will observe, record and cost implementation for 6 months. The knowledge/skills questionnaire will be repeated at the end of implementation and results will inform the purposive selection of 10 child-care providers and parents for qualitative interviews. Descriptive statistics and thematic framework approach will respectively be used to analyse quantitative and qualitative data and identify drivers of feasibility.Ethics and disseminationThe study has been approved by Amref Health Africa’s Ethics and Scientific Review Committee (Ref: P7802020 on 20th April 2020) and the University of York (Ref: HSRGC 20th March 2020). Findings will be published and continual engagement with decision-makers will embed findings into child-care policy and practice.

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