scholarly journals Do patient-reported outcome measures measure up? A qualitative study to examine perceptions and experiences with heart failure proms among diverse, low-income patients

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Jonathan Davis ◽  
Kristan Olazo ◽  
Maribel Sierra ◽  
Michelle E. Tarver ◽  
Brittany Caldwell ◽  
...  
Keyword(s):  
Mental Health ◽  
Heart Failure ◽  
Health Care ◽  
Low Income ◽  
Underserved Populations ◽  
White Male ◽  
Safety Net ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Patients With Heart Failure

Abstract Background The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a Patient-Reported Outcome Measure (PROM) used to evaluate the health status of patients with heart failure (HF) but has predominantly been tested in settings serving predominately white, male, and economically well-resourced populations. We sought to examine the acceptability of the shorter version of the KCCQ (KCCQ-12) among racially and ethnically diverse patients receiving care in an urban, safety-net setting. Methods We conducted cognitive interviews with a diverse population of patients with heart failure in a safety net system to assess their perceptions of the KCCQ-12. We conducted a thematic analysis of the qualitative data then mapped themes to the Capability, Opportunity, Motivation Model of Behavior framework. Results We interviewed 18 patients with heart failure and found that patients broadly endorsed the concepts of the KCCQ-12 with minor suggestions to improve the instrument’s content and appearance. Although patients accepted the KCCQ-12, we found that the instrument did not adequately measure aspects of health care and quality of life that patients identified as being important components of managing their heart failure. Patient-important factors of heart failure management coalesced into three main themes: social support, health care environment, and mental health. Conclusions Patients from this diverse, low-income, majority non-white population experience unique challenges and circumstances that impact their ability to manage disease. In this study, patients were receptive to the KCCQ-12 as a tool but perceived that it did not adequately capture key health components such as mental health and social relationships that deeply impact their ability to manage HF. Further study on the incorporation of social determinants of health into PROMs could make them more useful tools in evaluating and managing HF in diverse, underserved populations.

Service Learning in Health Care for Underserved Communities: University of Iowa Mobile Clinic, 2019

2020 ◽  
Vol 110 (9) ◽  
pp. 1304-1307
Author(s):  
Melissa L. Palma ◽  
Andrea Arthofer ◽  
Kristen M. Halstead ◽  
Joyce M. Wahba ◽  
Denise A. Martinez
Keyword(s):  
Health Care ◽  
Rural Communities ◽  
Service Learning ◽  
Low Income ◽  
Underserved Populations ◽  
Safety Net ◽  
Mobile Clinic ◽  
University Of Iowa ◽  
Basic Services ◽  
Source Of Care

The University of Iowa Mobile Clinic (UIMC) is an interdisciplinary student-run free medical clinic founded in 2002. UIMC provides free health screenings, education, and basic services to underserved populations in Iowa: immigrants, refugees, migrant farmworkers, individuals experiencing homelessness, low-income individuals, and people who live in rural communities. Forty-four percent of patients surveyed use UIMC as their only source of care. Ninety-seven percent of patients surveyed rate care as excellent or good. UIMC is a crucial safety net health care resource in Iowa to improve health equity.

scholarly journals Transportation and Other Nonfinancial Barriers Among Uninsured Primary Care Patients

2018 ◽  
Vol 5 ◽  
pp. 233339281774968 ◽  
Author(s):  
Akiko Kamimura ◽  
Samin Panahi ◽  
Zobayer Ahmmad ◽  
Mu Pye ◽  
Jeanie Ashby
Keyword(s):  
Health Care ◽  
Low Income ◽  
Underserved Populations ◽  
Unmet Need ◽  
Care Facility ◽  
Well Being ◽  
Safety Net ◽  
The United States ◽  
Free Clinic ◽  
Transportation Barriers

Introduction: Nonfinancial barriers are frequent causes of unmet need in health-care services. The significance of transportation barriers can weigh more than the issues of access to care. The purpose of this cross-sectional study was to examine transportation and other nonfinancial barriers among low-income uninsured patients of a safety net health-care facility (free clinic). Methods: The survey data were collected from patients aged 18 years and older who spoke English or Spanish at a free clinic, which served uninsured individuals in poverty in the United States. Results: Levels of transportation barriers were associated with levels of other nonfinancial barriers. Higher levels of nonfinancial barriers were associated with elevation in levels of stress and poorer self-rated general health. Higher educational attainment and employment were associated with an increase in other nonfinancial barriers. Conclusion: Focusing only on medical interventions might not be sufficient for the well-being of the underserved populations. Future studies should examine integrative care programs that include medical treatment and social services together and evaluate such programs to improve care for underserved populations.

scholarly journals Correction to: Development of a conceptual model and patient-reported outcome measures for assessing symptoms and functioning in patients with heart failure

2020 ◽  
Vol 29 (10) ◽  
pp. 2849-2849
Author(s):  
Olga Moshkovich ◽  
Katy Benjamin ◽  
Katie Hall ◽  
Ryan Murphy ◽  
Robyn von Maltzahn ◽  
...  
Keyword(s):  
Heart Failure ◽  
Conceptual Model ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Patients With Heart Failure

The article Development of a conceptual model and patient-reported outcome measures for assessing symptoms and functioning in patients with heart failure.

Outsourcing Responsibility

2017 ◽  
Author(s):  
Cathleen E. Willging ◽  
Elise M. Trott
Keyword(s):  
Health Care ◽  
Low Income ◽  
Underserved Populations ◽  
Care Delivery ◽  
Health Care Systems ◽  
Behavioral Health Care ◽  
Safety Net ◽  
Treatment Needs ◽  
Health Care Safety Net ◽  
Care Systems

Cathleen E. Willging and Elise M. Trott argue that politically driven processes of the past have shaped the current context of mental health care delivery in New Mexico. Provisions of the ACA, including the expansion of Medicaid and outreach to underserved populations, offered the possibility of improving access and services for New Mexicans struggling with unmet treatment needs. However, as the authors argue, public stewards manipulated key ACA provisions to propagate unsubstantiated allegations of waste, fraud, and corruption against safety-net service providers. This chapter shows how public-private partnerships in the Medicaid arena, discourses of transparency, and technologies of accountability can engender truthiness claims, obscure vital information, destabilize a behavioral health care safety net, and deny low-income citizens care. They argue that scholars have the responsibility to attend to the “total bureaucratization” of government-funded health care systems that also allows such abuse of authority.

Predictors of patient-reported outcomes at discharge in patients with heart failure

2020 ◽  
pp. 147451512090239
Author(s):  
Anne A Rasmussen ◽  
Søren P Johnsen ◽  
Selina K Berg ◽  
Trine B Rasmussen ◽  
Britt Borregaard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Outcome Measures ◽  
Short Form ◽  
Illness Perception ◽  
Length Of Hospital Stay ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Illness Perception Questionnaire ◽  
Patient Reported ◽  
Patients With Heart Failure

Background: It is well-established that heart failure has a negative impact on quality of life. However, little is known about patient-related predictors of health-related quality of life, anxiety and depression, symptoms and illness perception among patients with heart failure. Aim: To study the association between patient-related predictors and patient-reported outcome measures at discharge from hospital in a cohort of patients with heart failure. Methods: We used data from 1506 patients with heart failure, participating in the national DenHeart Survey of patient-reported outcome measures in patients with heart disease. The potential patient-related predictors included demographic, administrative, clinical and socioeconomic factors. The patient-reported outcome measures included six questionnaires: the Short Form-12, the Hospital Anxiety and Depression Scale, the EuroQol five-dimensional, five-level questionnaire, the HeartQoL, the Brief Illness Perception Questionnaire and the Edmonton Symptom Assessment Scale. Data were linked to national patient registry data and medical records. We performed multivariable linear and logistic regression analyses. Results: In adjusted linear regression analyses we found that a length of hospital stay of >2 days was associated with worse scores across questionnaires, except for the Brief Illness Perception Questionnaire. Higher comorbidity level was associated with worse scores across all questionnaires, whereas low social support was associated with worse scores across questionnaires, except for the physical domain of the Short Form-12 and the HeartQoL global score. Conclusions: This study identified length of hospital stay > 2 days, a higher comorbidity level and low social support to be associated with worse scores across questionnaires at discharge from a cardiac-related hospitalisation in patients with heart failure.

scholarly journals Remote monitoring of patients with heart failure during the first national lockdown for COVID-19 in France

2021 ◽  
Author(s):  
Sylvain Ploux ◽  
Marc Strik ◽  
Saer Abu-Alrub ◽  
F Daniel Ramirez ◽  
Samuel Buliard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Heart Rate ◽  
Remote Monitoring ◽  
Marked Decrease ◽  
Clinical Status ◽  
Health Care Use ◽  
Physiological Variables ◽  
Patients With Heart Failure ◽  
Vital Parameters

Abstract Background Multiparametric remote monitoring of patients with heart failure (HF) has the potential to mitigate the health risks of lockdowns for COVID-19. Aims To compare health care use, physiological variables, and HF decompensations during one month before and during the first month of the first French national lockdown for COVID-19 among patients undergoing remote monitoring. Methods Transmitted vital parameters and data from cardiac implantable electronic devices were analyzed in 51 patients. Medical contact was defined as the sum of visits and days of hospitalization. Results The lockdown was associated with a marked decrease in cardiology medical contact (118 days before vs 26 days during, -77%, p = 0.003) and overall medical contact (180 days before vs 79 days during, -58%, p = 0.005). Patient adherence with remote monitoring was 84±21% before and 87±19% during lockdown. The lockdown was not associated with significant changes in various parameters, including physical activity (2±1 to 2±1 h/day), weight (83±16 to 83±16 kg), systolic blood pressure (121±19 to 121±18 mmHg), heart rate (68±10 to 67±10 bpm), heart rate variability (89±44 to 78±46 ms, p = 0.05), atrial fibrillation burden (84±146 vs 86±146 h/month), or thoracic impedance (66±8 to 66±9 Ω). Seven cases of HF decompensations were observed before lockdown, all but one of which required hospitalization, versus six during lockdown, all but one of which were managed remotely. Conclusions The lockdown restrictions caused a marked decrease in health care use but no significant change in the clinical status of HF patients under multiparametric remote monitoring. lay summary The first French COVID-19 lockdown had a huge detrimental impact on conventional health care use (-78% in cardiology medical contact). However the lockdown had little impact over the short-term, if any, on vital parameters and the clinical status of patients with heart failure who were adherent to multiparametric remote monitoring. This remote monitoring strategy allowed early identification and home management of most of the heart failure decompensations during the lockdown.

scholarly journals A novel patient-reported outcome monitoring with clinical feedback system in bariatric surgery care: study protocol, design and plan for evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037685
Author(s):  
Pål André Hegland ◽  
Anny Aasprang ◽  
Ronette L Kolotkin ◽  
Christian Moltu ◽  
Grethe S Tell ◽  
...  
Keyword(s):  
Mental Health ◽  
Bariatric Surgery ◽  
Data Protection ◽  
Healthcare Professionals ◽  
Feedback System ◽  
Patient Reported Outcome ◽  
Outpatient Clinics ◽  
Outcome Monitoring ◽  
Patient Reported ◽  
Clinical Feedback

BackgroundConsultations before and after bariatric surgery should include structured assessments of patients’ health-related quality of life (HRQOL) and mental health. One way to conduct this assessment is to implement patient-reported outcome monitoring with a clinical feedback system (PRO/CFS).AimWe will explore patients’ and healthcare professionals’ experiences when a PRO/CFS is an integrated part of bariatric surgery care.Methods and analysesThis is a design paper in which a PRO/CFS will be implemented in two bariatric outpatient clinics. All patients who have an appointment with a healthcare professional prior to, and 3 and 12 months after surgery, will be asked to complete six digital questionnaires measuring HRQOL, mental health, bowel symptoms and eating self-efficacy prior to each consultation. A digital summary report generated from the patient’s responses will form the basis for the clinical consultation. A team of patient representatives, healthcare professionals and researchers will be involved in all phases of designing the PRO/CFS to ensure its relevance for clinical consultations. The patients’ experiences will be explored with a generic 12-item questionnaire, developed for use in outpatient clinics, prior to and 12 months after bariatric surgery. We will conduct focus-group interviews with patients and healthcare professionals to explore their experiences when PRO/CFS is integrated into the consultations.Ethics and disseminationWritten informed consent will be obtained for all participants in the study. The project is approved by the Norwegian Centre for Research Data, Department of Data Protection Services (ref. no. 282738). The project has also undergone Data Protection Impact Assessments, both at Førde Hospital Trust and at St. Olav Hospital (registration no. 2016/3912). Data from the qualitative and quantitative studies will be kept in de-identified form in a secured research database, and the findings will be published in international peer-reviewed journals and presented at scientific conferences.

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