Obstetric Provider Perspectives on Postpartum Patient Navigation for Low-Income Patients

2021 ◽  
pp. 109019812110431
Author(s):  
Rachel S. Ruderman ◽  
Emma C. Dahl ◽  
Brittney R. Williams ◽  
Joe M. Feinglass ◽  
Michelle A. Kominiarek ◽  
...  
Keyword(s):  
Focus Groups ◽  
Low Income ◽  
Patient Navigation ◽  
Medical Center ◽  
Comparative Method ◽  
Academic Medical Center ◽  
Obstetric Care ◽  
Successful Implementation ◽  
Semistructured Interview ◽  
Provider Perspectives

Background Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients. Method Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method. Results Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. Conclusions Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.

scholarly journals Policies and procedures governing patient portal use at an Academic Medical Center

JAMIA Open ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 479-488
Author(s):  
Bryan D Steitz ◽  
Joseph Isaac S Wong ◽  
Jared G Cobb ◽  
Brian Carlson ◽  
Gaye Smith ◽  
...  
Keyword(s):  
Government Regulation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Successful Implementation ◽  
Patient Portal ◽  
Patient Portals ◽  
Identity Verification ◽  
Policies And Procedures ◽  
Academic Medical ◽  
And Function

Abstract Background and Objective Patient portal use has increased over the last two decades in response to consumer demand and government regulation. Despite growing adoption, few guidelines exist to direct successful implementation and governance. We describe the policies and procedures that have governed over a decade of continuous My Health at Vanderbilt (MHAV) patient portal use. Methods We examined MHAV usage data between May 2007 and November 2017. We classified patient portal activity into eight functional categories: Appointment, Billing, Document Access, Genetics, Health Result, Immunization, Medication, and Messaging. We describe our operating policies and measure portal uptake, patient account activity, and function use over time. Results By the end of the study period, there were 375 517 registered accounts. Policies made MHAV available to competent adults and adolescents 13 and over. Patients signed up for a limited access account online, which could be upgraded to a full-access account after identity verification. Patients could assign proxy accounts to family and caregivers, which permitted nonpatient access to select MHAV functions. Laboratory and radiology results were accessible via MHAV. Results were classified into three groups based on sensitivity, which govern the length of delay before results appeared in MHAV. Discussion and Conclusion Patient portals offer significant opportunity to engage patients in their healthcare. However, there remains a need to understand how policies can promote uptake and use. We anticipate that other institutions can apply concepts from our policies to support meaningful patient portal engagement.

Patient and Provider Perceptions of a Patient Navigation Program to Improve Postpartum Care Among Publicly Insured Women

2019 ◽  
Author(s):  
Fengling Hu ◽  
Angelina Strohbach ◽  
Noelle G. Martinez ◽  
Melissa A. Simon ◽  
Lynn M. Yee
Keyword(s):  
Patient Satisfaction ◽  
Low Income ◽  
Patient Navigation ◽  
Clinical Care ◽  
Comparative Method ◽  
Interpersonal Relationship ◽  
Program Satisfaction ◽  
Provider Perceptions ◽  
Navigation Program ◽  
Publicly Insured

Abstract Objective This study was aimed to assess patient and provider perceptions of a postpartum patient navigation program. Study Design This was a mixed-method assessment of a postpartum patient navigation program. Navigating New Motherhood (NNM) participants completed a follow-up survey including the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale and an open-ended question. PSN-I scores were analyzed descriptively. Eighteen provider stakeholders underwent in-depth interviews to gauge program satisfaction, perceived outcomes, and ideas for improvement. Qualitative data were analyzed by the constant comparative method. Results In this population of low-income, minority women, participants (n = 166) were highly satisfied with NNM. The median PSN-I score was 45 out of 45 (interquartile range [IQR]: 43–45), where a higher score corresponds to higher satisfaction. Patient feedback was also highly positive, though a small number desired more navigator support. Provider stakeholders offered consistently positive program feedback, expressing satisfaction with NNM execution and outcomes. Provider stakeholders noted that navigators avoided inhibiting clinic workflow and eased clinic administrative burden. They perceived NNM improved multiple clinical and satisfaction outcomes. All provider stakeholders believed that NNM should be sustained long-term; suggestions for improvement were offered. Conclusion A postpartum patient navigation program can perceivably improve patient satisfaction, clinical care, and clinic workflow without burden to clinic providers.

scholarly journals A Qualitative Exploration to Understand Hospitalists’ Attitude Toward the Patient Experience Scoring System

2020 ◽  
Vol 7 (6) ◽  
pp. 1036-1043 ◽  
Author(s):  
Ankur Segon ◽  
Yogita Segon ◽  
Vivek Kumar ◽  
Hirotaka Kato
Keyword(s):  
Scoring System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
Semistructured Interview ◽  
Academic Medical ◽  
Knowledge And Attitude ◽  
Patient’S Perception ◽  
The Impact ◽  
Hcahps Survey

Patient’s perception of their inpatient experience is measured by the Center for Medical Services’ (CMS) administered Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey. There is scant existing literature on physicians’ perceptions toward the HCAHPS scoring system. Understanding hospitalist knowledge and attitude toward the HCAHPS survey can help guide efforts to impact HCAHPS survey scores by improving the patient’s perception of their hospital experience. The goal of this study is to explore hospitalists’ knowledge and perspective of the physician communication domain of the HCAHPS survey at an academic medical center. Seven hospitalists at an academic medical center were interviewed for this report using a semistructured interview. Thematic analysis approach was used to analyze data. Open, line-by-line coding was performed on all 7 transcripts. Categories were derived in an inductive fashion. Categories were refined using the techniques of constant comparison and axial coding. We generated themes reflecting hospitalists’ knowledge of the HCAHPS scoring system, their perception of the HCAHPS scoring system and the impact of the HCAHPS scoring system on their practice. While hospitalists acknowledged physician–patient communication is a challenging area to study, they are unlikely to embrace the feedback provided by HCAHPS surveys. There is a need to deploy tactics that provide timely and actionable feedback to providers on their bedside communication skills.

Prescribers' perceptions on the impact of hydrocodone rescheduling on geriatric pain management: A qualitative study

2018 ◽  
Vol 14 (5) ◽  
pp. 317-326
Author(s):  
Julianna Fernandez, PharmD, BCPS, CGP ◽  
James Douglas Thornton, PhD, PharmD, BCPS ◽  
Sanika Rege, MS ◽  
Benjamin Lewing, MS ◽  
Shweta Bapat, BPharm ◽  
...  
Keyword(s):  
Pain Management ◽  
Focus Groups ◽  
Geriatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Prescribing Patterns ◽  
Cross Sectional ◽  
Term Care ◽  
The Impact

Objective: To qualitatively assess prescribers’ perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings.Design: This was a cross-sectional study.Setting: Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016.Participants: Prescribers who manage noncancer pain for geriatric patients were recruited. Focus groups were recorded, transcribed, and then analyzed using ATLAS.ti Qualitative Data Analysis software. Codes were derived from six primary research questions and results were summarized into key themes regarding the impact of rescheduling.Main outcome measures: Prescribers’ perceptions regarding hydrocodone rescheduling.Results: Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. They expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions. This led to substituting hydrocodone with potentially less effective pain medications, the inability to issue refills on hydrocodone prescriptions, and an ethical concern over prescribing hydrocodone to patients not under their direct care. Additionally, rescheduling has affected the coordination of care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred.Conclusions: The majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management after discharge. Rescheduling has changed physicians’ hydrocodone prescribing patterns, leading to more caution when prescribing hydrocodone and greater use of the PMP. Future studies should assess geriatric patients’ satisfaction and quality of life regarding pain management since hydrocodone was rescheduled.

scholarly journals Development of an innovative adult attention-deficit hyperactivity disorder clinic

2020 ◽  
Vol 10 (5) ◽  
pp. 296-300
Author(s):  
Kelly C. Lee ◽  
Estelle Kim ◽  
Jaye Kim ◽  
Benjamin Malcolm ◽  
Grace M. Kuo ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Medical Center ◽  
Academic Medical Center ◽  
Collaborative Practice ◽  
Psychiatric Evaluation ◽  
Successful Implementation ◽  
Hyperactivity Disorder ◽  
Collaborative Practice Agreement

Abstract Pharmacist-psychiatrist collaborative clinic models in specialty mental health clinics are limited, and there has been only 1 report of a clinic focused on adult attention-deficit hyperactivity disorder (ADHD). In this article, we describe the successful implementation of a pharmacist-psychiatrist collaborative practice agreement in an adult ADHD clinic at an academic medical center. Adult patients diagnosed with ADHD after a comprehensive assessment, including a full neuropsychological evaluation, were enrolled in the collaborative treatment clinic. The collaboration was a partnership between a psychiatry department and a school of pharmacy at a public university. We report the details of 58 patients and 774 patient encounters at the collaborative pharmacist-psychiatrist practice from March 2015 through June 2018. The visits were billed using traditional medical billing codes for follow-up visits. Pharmacist practice opportunities included psychiatric evaluation, medication management, counseling, and referral to auxiliary services. Challenges to the clinic's success included limited pharmacist time, prescriptive authority, and reimbursement for services from payors. A collaborative practice model targeted at adult ADHD patients may be a unique clinic setting for psychiatric pharmacists.

Use of a theoretical framework to examine declines in clinical trial enrollment.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18037-e18037
Author(s):  
Christine B. Mackay ◽  
Kerry Hepler ◽  
Christine Makosky Daley ◽  
Joanna Veazey Brooks
Keyword(s):  
Clinical Trial ◽  
Focus Groups ◽  
Research Effort ◽  
Medical Center ◽  
Academic Medical Center ◽  
Theoretical Domains Framework ◽  
Theoretical Framework ◽  
Community Oncology ◽  
Before And After ◽  
Clinical Trial Enrollment

e18037 Background: Clinical trial enrollment at a group of community oncology sites dropped significantly surrounding acquisition by an academic medical center. While previous research used empirical data to identify enrollment barriers, this study used a theoretical framework to investigate research site personnel behavior associated with enrollment, and to further explore clinical trial enrollment barriers. Methods: Data from focus groups and interviews were analyzed using the integrated TDF and COM-B theoretical framework [1] . [1] Theoretical Domains Framework with Capability, Opportunity, Motivation Behavior Wheel. Results: Fifty-six community personnel [2] participated in focus groups and interviews about enrollment experiences before and after the acquisition. Participants described how changes in the workplace and resources affected their Opportunity to enroll: "It's kind of hard to put somebody on a study when you don't have one available." -cs "You can't grow a research department by cutting staff. What message does it send to the organization as far as the importance of research? …it makes you wonder whether the organization truly backs the research effort." -m Physician participants specifically shared that the lack of time and staff devoted to research hampered enrollment efforts, consequently affecting their Motivation: “Current road block is that doc doesn't have time to go through the patient records, so if [the study coordinator] could determine eligibility before the patient visit, that would be helpful.” -p Participants expressed frustration in not knowing the processes for opening trials, therefore their Capability was affected. “I think [in the past], we knew more about what was out there, where I don't see as much of that here now. I don't know if it's because we don't have a research nurse or we are not getting a list [of trials] anymore or what is going on." -cs [2] Quotes from personnel cs = clinic staff, m = manager, p = provider. Conclusions: Participants perceived many barriers to clinical trial enrollment after the acquisition. To optimally continue providing services as expected, support systems need to be maintained. This study provided evidence of using the TDF for exploring enrollment barriers.

“I had already made up my mind.” The impact of prior experience and health care perceptions on decision making in women with early-stage breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 228-228
Author(s):  
Rebecca England ◽  
Valerie Lawhon ◽  
Audrey S. Wallace ◽  
Stacey A. Ingram ◽  
Courtney Williams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Medical Center ◽  
Comparative Method ◽  
Academic Medical Center ◽  
Axillary Node ◽  
Additional Treatment ◽  
Early Stage Breast Cancer ◽  
The Impact

228 Background: Shared decision-making (SDM) occurs when informed patients partner with their oncologists to incorporate personal preferences into treatment. Even before engaging with an oncologist about treatment options, patients may have personal experiences or knowledge of other’s experiences with breast cancer that frame their decision-making. This study sought to understand how prior experiences and knowledge drive preferences in early stage breast cancer treatment approaches. Methods: This qualitative study included early stage breast cancer (BC) patients at an academic medical center in the Deep South. Women age ≥18 with an AJCC stage I-III BC diagnosis were invited to complete semi-structured interviews with a trained interviewer. Interviews were audio-recorded, transcribed, and analyzed by two independent coders utilizing a constant comparative method from an a priori conceptual model based on the Ottawa Framework. Major themes and exemplary quotes related to decision-making preferences were extracted. Results: Women (n = 33) interviewed were an average age of 74 (4.2 SD), and 19% of participants were African American. Many women were given the option to omit treatments, such as chemotherapy or radiation therapy, based on hormone receptor status and axillary node involvement. Major themes related to a desire for more treatment were past experiences with family members having cancer or an impression that additional treatment would be more effective. For women that opted out of treatments, prior knowledge of potential physical side effects from friends, family, and other cancer survivors were cited as a major deterrent. Perceptions of low recurrence risk also influenced desire to forgo treatments. Conclusions: Women presenting with early stage BC had varied healthcare experiences, which resulted in preconceived ideas about receiving breast cancer treatments. Consideration of these themes may aid physicians’ ability to address individual concerns to further personalize patient care, thus enhancing the patient-physician partnership. These findings will ultimately assist in improving patient engagement in SDM.

Sign in / Sign up

Export Citation Format

Share Document