Enhancing quality of prosthetic services with process and outcome information

2016 ◽  
Vol 41 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Allen W Heinemann ◽  
Linda Ehrlich-Jones ◽  
Lauri Connelly ◽  
Patrick Semik ◽  
Stefania Fatone
Keyword(s):  
Quality Improvement ◽  
Performance Management ◽  
The United States ◽  
Routine Care ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
Outcome Monitoring ◽  
Patient Reported ◽  
Functional Scores

Background: Prosthetic clinics in the United States must attain accreditation in order to receive reimbursement from Medicare. The accreditation process requires clinics to establish and implement performance management plans and quality improvement activities. This report describes the experience of seven prosthetic clinics in collecting patient-reported outcome data and using it to improve quality of services. Objectives: To describe the experience of prosthetic clinics implementing outcome monitoring and quality improvement activities as part of routine patient care. Study design: Qualitative, ethnographic design. Methods: Clinics incorporated the Orthotics Prosthetics Users’ Survey into routine care for patients aged 18 years and older who received a new lower limb prosthesis or socket. Orthotics Prosthetics Users’ Survey measures lower extremity functional status, quality of life, and satisfaction with device and services. Clinics selected Orthotics Prosthetics Users’ Survey-derived indicators on which to implement quality improvement action plans. Results: Seven clinics participated, but only three were able to sustain data collection. Two clinics initiated quality improvement activities focused on improving declining satisfaction or functional scores. Conclusions: Quality improvement activities based on patient-reported outcomes require a high degree of organizational commitment and support. External facilitation can support clinics’ quality improvement activities. Clinical relevance This project illustrates the challenges of sustaining quality improvement activities using patient-reported outcome data in prosthetic clinics.

scholarly journals Utilizing the Axon Registry® for quality improvement

2018 ◽  
Vol 8 (5) ◽  
pp. 456-461 ◽  
Author(s):  
Anup D. Patel ◽  
Joseph V. Fritz ◽  
David A. Evans ◽  
Karen B. Lundgren ◽  
Katie Hentges ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
Quality Data ◽  
Data Registry ◽  
Patient Reported ◽  
Essential Function ◽  
American Academy Of Neurology ◽  
Quality Improvement Tool

In 2015, the American Academy of Neurology began development of a clinical quality data registry now known as the Axon Registry®. The data collected by the Axon Registry and reported back to participants include performance on a number of quality measures relevant to neurology practice. While the Axon Registry may serve any number of needs for neurology practices, the essential function of the registry is to inform neurologists regarding the quality of their care and provide them with a tool to establish not only performance baselines but progress toward improved quality of care. This article includes 2 case studies of how the Axon Registry has been implemented in neurology practices to date. In the future, implementation of patient-reported outcome data and additional outcome measures will be necessary to expand the reach and effectiveness of the Axon Registry as a quality improvement tool.

scholarly journals From Inpatient Notes to Outpatient Followup: Enhancing the Rhinology Service in a Tertiary Centre through Student Led Projects

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
M. Sayma ◽  
R. Hyne ◽  
M. Sharma ◽  
L. Kyle ◽  
M. Abo Khatwa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Reported Outcome Measures ◽  
Discharge Summary ◽  
Routine Care ◽  
Patient Reported Outcome ◽  
Operative Note ◽  
Tertiary Centre ◽  
Patient Reported ◽  
Electronic Discharge Summary

Introduction. Medical students can use systems to help improve the quality of care in a unit. Following the review of care within the ENT department at a tertiary centre a number of quality improvement projects were put in place.Methods. The following interventions were established: (1) creation of an outpatient telephone enquiry clinic, (2) development of a rhinology database, (3) introduction of operative note templates, and (4) construction of electronic discharge summary templates (eDSTs).Discussion and Outcomes. (1) Consultant telephone inquiry clinics were successfully organised and showed high levels of patient satisfaction. (2) A database to collect patient reported outcome measures was piloted within rhinology outpatients; the results suggest that such a database would be simple to introduce and yield benefits for patients and the department. (3) Operative note templates for FESS procedures were implemented with a view to improving the continuity of care onto the ward; these have become well established and further steps to integrate these into routine care are being taken. (4) eDSTs specific to FESS and septorhinoplasty procedures were introduced with a view to increasing completion speed of templates and adherence to Royal College of Physician Guidance.

scholarly journals Micro-Meso-Macro Practice Tensions in Using Patient-Reported Outcome and Experience Measures in Hospital Palliative Care

2018 ◽  
Vol 29 (4) ◽  
pp. 510-521 ◽  
Author(s):  
Marian Krawczyk ◽  
Richard Sawatzky ◽  
Kara Schick-Makaroff ◽  
Kelli Stajduhar ◽  
Joakim Öhlen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Analytical Framework ◽  
Routine Care ◽  
Patient Reported Outcome ◽  
Scope Of Practice ◽  
Routine Practice ◽  
Macro Practice ◽  
Patient Reported ◽  
Critical Consideration

This article applies a micro-meso-macro analytical framework to understand clinicians’ experiences and perspectives of using patient-reported outcome and experience measures (PROMs and PREMs) in routine hospital-based palliative care. We structure our discussion through qualitative analysis of a design and implementation project for using an electronic tablet-based tool among hospital-based palliative clinicians to assess patients’ and their family caregivers’ quality of life concerns and experiences of care. Our analysis identified three categories of practice tensions shaping clinicians’ use of PROMs and PREMs in routine care: tensions surrounding implementation, tensions in standardization and quantification, and tensions that arose from scope of practice concerns. Our findings highlight that clinicians necessarily work within the confluence of multiple system priorities, that navigating these priorities can result in irreducible practice tensions, and that awareness of these tensions is a critical consideration when integrating PROMs and PREMs into routine practice.

scholarly journals Consilium Smartphone App for Real-World Electronically Captured Patient-Reported Outcome Monitoring in Cancer Patients Undergoing anti-PD-L1-Directed Treatment

2020 ◽  
Vol 13 (2) ◽  
pp. 491-496 ◽  
Author(s):  
Andreas Trojan ◽  
Urs Huber ◽  
Mathis Brauchbar ◽  
Ulf Petrausch
Keyword(s):  
Patient Reported Outcomes ◽  
Patient Reported Outcome ◽  
Smartphone App ◽  
Safety Issues ◽  
Electronic Reporting ◽  
Outcome Monitoring ◽  
Patient Reported ◽  
Severity Grading ◽  
Insight Into

Digital patient monitoring gains importance for quality of clinical cancer care. Our case report provides insight into usability and acceptance of a smartphone app for monitoring of electronically captured patient-reported outcomes in patients undergoing immunotherapy. During 3 months, 6 patients with advanced or metastatic PD-L1-positive cancer of the lung, prostate, and bladder who underwent checkpoint immunotherapy were using the Consilium app for standardized and structured electronic reporting of symptoms and therapy side effects. We evaluated the number and quality of symptom entries as well as usability and safety of shared reporting between the patient and the treating physician. Duration of anti-PD-L1-directed immunotherapy in the 6 patients ranged from 4 to 10 months and comprised a total of 21 anti-PD-L1-directed immunotherapy cycles. Patients reported between 4 and 16 different symptoms, of which the most frequent (57%) were dry cough, fatigue, shortness of breath, fever, and appetite loss. Overall, 1,279 symptom entries were counted, corresponding to 2.4 symptom entries per patient per day. Symptom severity grading ranged from 0.1 (very slight symptoms) to 7.8 (severe symptoms), which triggered prespecified alerts in 4 of the 6 patients. No unplanned visits were noted, and no safety issues occurred. Satisfaction with the app usability was high, as was the beneficial effect on consultation. Usability and reviewed data entries indicate high shared reporting efforts of patients and treating physicians and overall satisfaction with electronically reported patient outcomes.

scholarly journals Quality improvement in vascular access: The role of patient-reported outcome measures

2019 ◽  
Vol 21 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Melanie Field ◽  
Karen Tullett ◽  
Aurangzaib Khawaja ◽  
Robert Jones ◽  
Nicholas G Inston
Keyword(s):  
Quality Of Life ◽  
Quality Improvement ◽  
Outcome Measures ◽  
Vascular Access ◽  
Venous Catheter ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Specific Patient ◽  
Patient Reported

Quality improvement initiatives should be aimed to enhance clinical outcomes, service delivery and quality of life for patients. For patients reliant on haemodialysis, vascular access is a lifeline. Survival differences relating to the type of vascular access are evident and many initiatives have focussed on increasing absolute rates of arteriovenous fistulas and/or decreasing central venous catheter use. While these have achieved some success quantitatively, the qualitative effects are less obvious. The aims of this review article are to explore the concepts of quality of care in vascular access. There is a paucity of studies into the effects of vascular access on the quality of life of dialysis patients, and where studies have been performed, generalised patient-reported outcome measures have been used. To facilitate the implementation of quality improvement programmes specifically for vascular access requires suitable tools. While existing patient-reported outcome measures may be applicable to vascular access, it is likely that these will require further evaluation, and the development of vascular access–specific patient-reported outcome measures may be required.

scholarly journals Oral Complementary Medicine Use among People with Inflammatory Arthritis: An Australian Rheumatology Association Database Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ashley Fletcher ◽  
Marissa Lassere ◽  
Lyn March ◽  
Catherine Hill ◽  
Graeme Carroll ◽  
...  
Keyword(s):  
Complementary Medicine ◽  
Inflammatory Arthritis ◽  
Tertiary Education ◽  
Nonparametric Test ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
Patient Reported ◽  
Strong Opioids ◽  
Over Time

Objectives. To describe oral complementary medicine (CM) use in people with inflammatory arthritis, associations with use, and changes in use over time. Methods. Demographic, clinical, and patient-reported outcome data from 5,630 participants with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA) were extracted from the Australian Rheumatology Association Database (ARAD), a national observational database. CM use at entry into ARAD was ascertained for participants recruited between 2002 and 2018. CM was categorised according to the NIH/Cochrane schema (fatty acids, herbs, or supplements). Logistic regression was used to assess associations between demographic characteristics and CM use. Change in CM use between 2006 and 2016 was investigated using a nonparametric test for trend of rate by year. Results. 2,156 (38.3%) ARAD participants were taking CM at enrolment (RA: 1,502/3,960 (37.9%), AS: 281/736 (38.2%), PsA: 334/749 (44.6%), and JIA: 39/185 (21.1%)). CM use was more prevalent in women (OR 1.3; 95% CI: 1.13-1.50), those with tertiary education (OR 1.32; 95% CI: 1.13-1.55), private health insurance (OR 1.26; (95% CI: 1.10-1.44), drinking alcohol sometimes (OR 1.22; 95% CI: 1.05-1.43), poorer function (HAQ) (OR 1.13; 95% CI: 1.02-1.24), use of NSAID (OR 1.32; 95% CI 1.17-1.50), weak (OR 1.21; 95% CI 1.05-1.41) but not strong opioids, and less prevalent in current smokers (OR 0.76; 95%: CI 0.63-0.91). CM use was not associated with pain, disease activity, or quality of life. The most common CMs were fish oils (N=1,489 users) followed by glucosamine (N=605). Both declined in use over time between 2006 and 2016 (27.5% to 21.4%, trend p=0.85 and 15.5% to 6.4%, trend p<0.01), respectively. Conclusion. Oral CM use is common among Australians with inflammatory arthritis. Its use is greater among women and those with tertiary education. Fish oil and glucosamine, the most common CMs, both declined in use over time.

Using Health-Related Quality of Life Assessments to Evaluate Care Support Within Medicaid

2008 ◽  
Vol 9 (2) ◽  
pp. 42-50 ◽  
Author(s):  
Richard T. Meenan ◽  
David Feeny ◽  
David Labby ◽  
Mark Spofford ◽  
David Mosen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Preliminary Evidence ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
Health Related Quality ◽  
Study Results ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related

CareOregon, an Oregon-based not-for-profit Medicaid health plan, successfully piloted a “CareSupport” model that identifies high-risk members and clinically stratifies them for intervention. Internal analyses indicate that CareSupport lowers utilization and cost; CareOregon, however, has lacked patient-reported outcome data on the health-related quality of life (HRQL) of CareSupport participants. Between September 2005 and November 2006, we conducted a pilot study in which the Health Utilities Index Mark 3 (HUI3), a generic preference-based measure of health status and HRQL, was integrated into CareOregon’s existing screening algorithm for possible admission into CareSupport. We obtained baseline data on 616 CareSupport candidates and 4-month HUI3 follow-up data on 143 candidates (104 CareSupport, 39 non-CareSupport). On a 0.00 (dead)-to-1.00 (perfect health) scale, the mean overall baseline HUI3 score for CareSupport patients was 0.18 (0.20 for non-CareSupport patients), comparable to baseline means reported elsewhere for much older patients immediately after suffering serious acute medical events, such as stroke or hip fracture. A 0.05 mean 4-month improvement in overall HRQL among CareSupport enrollees relative to non-CareSupport enrollees was clinically important but not statistically significant. A 0.10 improvement in HUI3 emotion was both statistically significant and clinically important. Study results provide good preliminary evidence of the value of patient-reported outcomes in clarifying individual illness burden and assessing intervention effectiveness.

scholarly journals How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis

2017 ◽  
Vol 23 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Joanne Greenhalgh ◽  
Sonia Dalkin ◽  
Elizabeth Gibbons ◽  
Judy Wright ◽  
Jose Maria Valderas ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
Realist Synthesis ◽  
Performance Data ◽  
Patient Reported ◽  
Main Programme

Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine ‘if then’ propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how aggregated patient-reported outcome measures data stimulate quality improvement, several lessons emerge from interventions sharing the same programme theories to help guide the increasing use of these measures.

scholarly journals Patient-Reported Outcomes for Quality of Life in SLE: Essential in Clinical Trials and Ready for Routine Care

2021 ◽  
Vol 10 (16) ◽  
pp. 3754
Author(s):  
Matthew H. Nguyen ◽  
Frank F. Huang ◽  
Sean G. O’Neill
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Lupus Erythematosus ◽  
Clinical Care ◽  
Routine Care ◽  
Patient Reported Outcome ◽  
Current Evidence ◽  
Patient Reported ◽  
Pro Tools

Patient-reported outcome (PRO) instruments are widely used to assess quality of life in Systemic Lupus Erythematosus (SLE) research, and there is growing evidence for their use in clinical care. In this review, we evaluate the current evidence for their use in assessing quality of life in SLE in both research and clinical settings and examine the different characteristics of the commonly used PRO tools. There are now several well-validated generic and SLE-specific tools that have demonstrated utility in clinical trials and several tools that complement activity and damage measures in the clinical setting. PRO tools may help overcome physician–patient discordance in SLE and are valuable in the assessment of fibromyalgia and type 2 symptoms such as widespread pain and fatigue. Future work will identify optimal PRO tools for different settings but, despite current limitations, they are ready to be incorporated into patient care.

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