scholarly journals Deriving and validating a brief measure of treatment burden to assess person-centered healthcare quality in primary care: a multi-method study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
David T. Eton ◽  
Mark Linzer ◽  
Deborah H. Boehm ◽  
Catherine E. Vanderboom ◽  
Elizabeth A. Rogers ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Medication Adherence ◽  
Care Quality ◽  
Community Dwelling ◽  
Self Management ◽  
Treatment Burden ◽  
Person Centered Care ◽  
Centered Care

Abstract Background In primary care there is a need for more quality measures of person-centered outcomes, especially ones applicable to patients with multiple chronic conditions (MCCs). The aim of this study was to derive and validate a short-form version of the Patient Experience with Treatment and Self-management (PETS), an established measure of treatment burden, to help fill the gap in quality measurement. Methods Patient interviews (30) and provider surveys (30) were used to winnow items from the PETS (60 items) to a subset targeting person-centered care quality. Results were reviewed by a panel of healthcare providers and health-services researchers who finalized a pilot version. The Brief PETS was tested in surveys of 200 clinic and 200 community-dwelling MCC patients. Surveys containing the Brief PETS and additional measures (e.g., health status, medication adherence, quality of care, demographics) were administered at baseline and follow-up. Correlations and t-tests were used to assess validity, including responsiveness to change of the Brief PETS. Effect sizes (ES) were calculated on mean differences. Results Winnowing and panel review resulted in a 34-item Brief PETS pilot measure that was tested in the combined sample of 400 (mean age = 57.9 years, 50% female, 48% white, median number of conditions = 5). Reliability of most scales was acceptable (alpha > 0.70). Brief PETS scores were associated with age, income, health status, and quality of chronic illness care at baseline (P < .05; rho magnitude range: 0.16–0.66). Furthermore, Brief PETS scores differentiated groups based on marital and education status, presence/absence of a self-management routine, and optimal/suboptimal medication adherence (P < .05; ES range: 0.25–1.00). Declines in patient-reported physical or mental health status over time were associated with worsening PETS burden scores, while improvements were associated with improving PETS burden scores (P < .05; ES range: 0.04–0.44). Among clinic patients, 91% were willing to complete the Brief PETS as part of their clinic visits. Conclusions The Brief PETS (final version: 32 items) is a reliable and valid tool for assessing person-centered care quality related to treatment burden. It holds promise as a means of giving voice to patient concerns about the complexity of disease management.

scholarly journals The Seniors’ Community Hub: An Integrated Model of Care for the Identification and Management of Frailty in Primary Care

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 18
Author(s):  
Marjan Abbasi ◽  
Sheny Khera ◽  
Julia Dabravolskaj ◽  
Bernadette Chevalier ◽  
Kelly Parker
Keyword(s):  
Primary Care ◽  
Gait Speed ◽  
Family Physicians ◽  
Community Dwelling ◽  
Integrated Models ◽  
Care Services ◽  
Interprofessional Teamwork ◽  
Team Working ◽  
Centered Care

(1) Background: Integrated models of primary care deliver the comprehensive and preventative approach needed to identify and manage frailty in older people. Seniors’ Community Hub (SCH) was developed to deliver person-centered, evidence-informed, coordinated, and integrated care services to older community dwelling adults living with frailty. This paper aims to describe the SCH model, and to present patient-oriented results of the pilot. (2) Methods: SCH was piloted in an academic clinic with six family physicians. Eligible patients were community dwelling, 65 years of age and older, and considered to be at risk of frailty (eFI > 0.12). Health professionals within the clinic received training in geriatrics and interprofessional teamwork to form the SCH team working with family physicians, patients and caregivers. The SCH intervention consisted of a team-based multi-domain assessment with person-centered care planning and follow-up. Patient-oriented outcomes (EQ-5D-5L and EQ-VAS) and 4-metre gait speed were measured at initial visit and 12 months later. (3) Results: 88 patients were enrolled in the pilot from April 2016–December 2018. No statistically significant differences in EQ-5D-5L/VAS or the 4-metre gait speed were detected in 38 patients completing the 12-month assessment. (4) Conclusions: Future larger scale studies of longer duration are needed to demonstrate impacts of integrated models of primary care on patient-oriented outcomes for older adults living with frailty.

scholarly journals Characteristics and health status of patients with and without confirmed HFpEF

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Deaton ◽  
F Forsyth ◽  
J Mant ◽  
D Edwards ◽  
R Hobbs ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cohort Study ◽  
Health Status ◽  
Functional Impairment ◽  
Funding Source ◽  
Walk Distance ◽  
Minute Walk Distance ◽  
Minute Walk

Abstract Aims Patients with heart failure with preserved ejection fraction (HFpEF) are usually older and multi-morbid and diagnosis can be challenging. The aims of this cohort study were to confirm diagnosis of HFpEF in patients with possible HFpEF recruited from primary care, to compare characteristics and health status between those with and without HFpEF, and to determine factors associated with health status in patients with HFpEF. Methods Patients with presumed HFpEF were recruited from primary care practices and underwent clinical assessment and diagnostic evaluation as part of a longitudinal cohort study. Health status was measured by Montreal Cognitive Assessment (MOCA), 6-minute walk test, symptoms, and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and quality of life (QoL) by EQ-5D-5L visual analogue scale (VAS). Results 151 patients (mean age 78.5±8.6 years, 40% women, mean EF 56% + 9.4) were recruited and 93 (61.6%) were confirmed HFpEF (those without HFpEF had other HF and cardiac diagnoses). Patients with and without HFpEF did not differ by age, MOCA, blood pressure, heart rate, NYHA class, proportion with atrial fibrillation, Charlson Comorbidity Index, or NT-ProBNP levels. Patients with HFpEF were more likely to be women, overweight or obese, frail, and to be more functionally impaired by 6 minute walk distance and gait speed than those without. Although not statistically significant, patients with HFpEF had clinically significant differences (&gt;5 points) on the physical limitations, symptom burden and clinical summary subscales of the KCCQ, but did not differ by other subscales or by EQ-5D-5L VAS (70±17 vs 73±19, p=0.385). More patients with HFpEF reported daytime dyspnoea (63% vs 46%, p=0.035) and fatigue (81% vs 61%, p=0.008), but not other symptoms compared to those without HFpEF. For both groups BMI was moderately negatively correlated with KCCQ subscale scores, and 6 minute walk distance was positively correlated with KCCQ subscales. Conclusions Nearly 40% were not confirmed as HFpEF indicating the challenges of diagnosis. Patients with confirmed HFpEF differed by sex, overweight/obesity, frailty, functional impairment, and symptoms but not by age or comorbidities from those without HFpEF. These differences were reflected in some subscale scores of the KCCQ, but not how patients reported their quality of life on the KCCQ QoL subscale and EQ-5D-5L VAS. Older patients with HFpEF reported relatively high QoL despite poor health status by functional impairment, frailty and symptoms. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research School of Primary Care Research

scholarly journals Implementation of Person-Centered Care: A Feasibility Study Using the WE-CARE Roadmap

2021 ◽  
Vol 18 (5) ◽  
pp. 2205
Author(s):  
Roman A. Lewandowski ◽  
Jędrzej B. Lewandowski ◽  
Inger Ekman ◽  
Karl Swedberg ◽  
Jan Törnell ◽  
...  
Keyword(s):  
Pilot Study ◽  
Feasibility Study ◽  
Health Care Professionals ◽  
Quality Care ◽  
Structured Interviews ◽  
Rehabilitation Hospital ◽  
Person Centered Care ◽  
Centered Care ◽  
Multi Disciplinary Team

Background: Person-Centered Care (PCC) is a promising approach towards improved quality of care and cost containment within health systems. It has been evaluated in Sweden and England. This feasibility study examines initial PCC implementation in a rehabilitation hospital for children in Poland. Methods: The WE-CARE Roadmap of enablers was used to guide implementation of PCC for patients with moderate scoliosis. A multi-disciplinary team of professionals were trained in the PCC approach and the hospital Information Technology (IT) system was modified to enhance PCC data capture. Semi-structured interviews were conducted with the nine health care professionals involved in the pilot study and three patients/parents receiving care. Transcribed data were analyzed via content analysis. Results: 51 patients and their families were treated via a PCC approach. High proportions of new PCC data fields were completed by the professionals. The professionals were able to implement the three core PCC routines and perceived benefits using the PCC approach. Patients and their families also perceived improved quality care. The WE-CARE framework enablers facilitated PCC implementation in this setting. Conclusions: This feasibility pilot study indicates that the Gothenburg PCC approach can be successfully transferred to a rehabilitation hospital in Poland with favorable perceptions of implementation by both professionals and patients/their families.

scholarly journals Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
Person Centered Care ◽  
Centered Care ◽  
The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

Dementia ◽  
2021 ◽  
pp. 147130122110126
Author(s):  
Alexandra E Harper ◽  
Lauren Terhorst ◽  
Marybeth Moscirella ◽  
Rose L Turner ◽  
Catherine V Piersol ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Scoping Review ◽  
Informal Caregivers ◽  
Nursing Home Care ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

Background Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers’ dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual’s care. However, little is known of the informal caregivers’ perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. Methods In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com , CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. Results We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. Conclusion Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers’ perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers’ satisfaction with nursing home care for residents with dementia.

scholarly journals Effects of an eHealth Intervention on Patient-Provider Interaction and Functional Health Literacy in Adults With Hypertension

2021 ◽  
Vol 7 ◽  
pp. 237796082110058
Author(s):  
Ronald L. Hickman ◽  
John M. Clochesy ◽  
Marym Alaamri
Keyword(s):  
Health Literacy ◽  
Community Dwelling ◽  
Attention Control ◽  
Functional Health ◽  
Self Management ◽  
Functional Health Literacy ◽  
Convenience Sample ◽  
Management Interventions ◽  
Modifiable Factors

Introduction Hypertension is a life-limiting, chronic condition affecting millions of Americans. Modifiable factors, quality of the patient-provider interaction and functional health literacy, have been linked to effective hypertension self-management. However, there has been limited interventional research targeting these modifiable factors. Electronic hypertension self-management interventions, in particular those incorporating virtual simulation, may positively influence the quality of the patient-provider interaction and functional health literacy status of adults with hypertension. Yet there is a dearth of evidence examining the efficacy of eHealth interventions targeting these modifiable factors of hypertension self-management. Objective Evaluate the effects of two electronic hypertension self-management interventions on the quality of the patient-provider interaction and functional health literacy in adults with hypertension. Methods A convenience sample of community-dwelling adults (>18 years) with hypertension were recruited and randomized to an avatar-based simulation (eSMART-HTN) or a video presentation on hypertension self-management (attention control). Participants were administered questionnaires to capture demographic characteristics, the quality of the patient-provider interaction, and functional health literacy. Questionnaire data were collected at baseline, and then monthly across three months. Two separate repeated measures analysis of covariance models were conducted to assess the effects of the interventions across the time points. Results The sample included 109 participants who were predominately middle-aged and older, nonwhite, and female. Scores for the quality of the patient-provider interaction demonstrated significant within-group changes across time. However, there were no significant differences in the quality of the patient-provider interaction or functional health literacy scores between experimental conditions while adjusting for covariates. Conclusion An avatar-based simulation (eSMART-HTN) intervention proved to have a positive effect on patient-provider interaction compared to an attention control condition. Although the results are promising, future research is needed to optimize the effectiveness of eSMART-HTN and enhance its efficacy and scalability in a larger cohort of adults with hypertension.

scholarly journals EVALUATION OF DIABETES SELF-MANAGEMENT EDUCATION IN PATIENTS WITH CONCOMITANT CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 73 (10) ◽  
pp. 2170-2174
Author(s):  
Oleksii M. Korzh
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Management Training ◽  
Cross Sectional Study ◽  
Self Management ◽  
Average Score ◽  
Cross Sectional ◽  
Self Monitoring ◽  
Diabetes Educators

The aim: Was to evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. Materials and methods: A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach’s reliability coefficient for each domain / subscale was ≥ 0.7. The data were analyzed using an independent selective t-test and one-way ANOVA. Results: More than half of the doctors provided “inadequate quality” of diabetes self-management in all areas. Doctors had the highest average score in the domain of “drug intake” (4.46 ± 0.61). Average scores in the “problem-solving domain” (3.52 ± 0.63) and “ being active domain” (3.46 ± 0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. Conclusions: The quality of doctors’ communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behavior associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.

scholarly journals The effect of self-management on the health-related quality of life in hypertensive patients in Xiamen, China

2020 ◽  
Author(s):  
Yanbing Zeng ◽  
Chenxi Lin ◽  
Fan Chen ◽  
Ya Fang
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Self Management ◽  
Average Score ◽  
Health Related Quality ◽  
Hypertensive Patients ◽  
Treatment Groups ◽  
Related Quality ◽  
Health Related

Abstract Background: A low HRQOL can be a risk factor for future cardiovascular events in patients with hypertension. Therefore, HRQOL should receive attention and be improved in the treatment of hypertension. The purpose of this study was to investigate if the association between treatment groups and Health-Related Quality of Life (HRQOL) of hypertension mediated by self-management, and to determine which factors of hypertension self-management influenced HRQOL. Methods: Hypertensive patients were selected by multi-stage stratified samping from “1+1+N” Physicians intervention (PI) group and the conventional management (CM) group in 5 communities of Xiamen, China. Patients were cross-sectionally assessed by validated self-reports using self-management Behavior Rating Scale and Quality of Life Instruments for Hypertension. A structural equation modeling (SEM) and a path analytic model were used to assess if the association between treatment groups and HRQOL was mediated by self-management. Results: A total of 1207 patients were included, of whom 48.55% were in the PI group. The average score of the HRQOL scale was 86.68, and the average score of the PI group was higher than the CM group (87.35 vs 86.04, respectively). Similar findings were observed for the self-management scale, in which the average score of the PI group was higher than the CM group (76.32 vs 72.00, respectively). Patients in the PI group had higher levels of self-management compared to the CM group except for management of emotion. SEM showed that the association between treatment groups and HRQOL was significantly mediated by self-management (a*b, 95% confidence intervals CI: 0.02,0.07) and that the single mediator (self-management) model explained 76.67% of the intervention effect. In the multivariable mediation model, the association between treatment groups and HRQOL was significantly mediated by management of medication adherence, sport and diet.Conclusions: The findings presented good evidence supporting that treatment groups are linked to HRQOL of hypertension via self-management. Specifically, management of medication adherence, sport, diet, and emotion are important for improving HRQOL.

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