scholarly journals Oncologic Home-Hospitalization Delivers a High-Quality and Patient-Centered Alternative to Standard Ambulatory Care: Results of a Randomized-Controlled Equivalence Trial

2021 ◽  
pp. 1564-1571
Author(s):  
Lieselot Cool ◽  
Jana Missiaen ◽  
Philip Debruyne ◽  
Hans Pottel ◽  
Veerle Foulon ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Service Use ◽  
Safety Data ◽  
Care Providers ◽  
Patient Centered ◽  
Potential Cost ◽  
High Quality ◽  
Randomized Controlled ◽  
Patient Reported

PURPOSE Given the increasing burden of cancer on patients, health care providers, and payers, the shift of certain outpatient procedures to the patients' homes (further indicated as oncologic home-hospitalization [OHH]) might be a high-quality, patient-centered, and cost-effective alternative to standard ambulatory cancer care (SOC). METHODS A randomized-controlled trial was conducted to evaluate the quality of a locally implemented model for OHH (n = 74) compared with SOC (n = 74). The model for OHH consisted of home administration of certain subcutaneous cancer drugs (full OHH) and home nursing assessments before ambulatory systemic cancer therapy (partial OHH). Quality was evaluated based on patient-reported quality of life (QoL) and related end points; service use and cost data; safety data; patient-reported satisfaction and preferences; and model efficiency. An equivalence design was used for primary end point analysis. Participants were followed during 12 weeks of systemic cancer treatment. RESULTS This trial demonstrated equivalence of both models (OHH v SOC) in terms of patient-reported QoL (95% CI not exceeding the equivalence margin of 10%). Full OHH resulted in significantly less hospital visits (mean of 5.6 ± 3.0 v 13.2 ± 4.6; P = .011). Partial OHH reduced waiting times for therapy administration at the day care unit with 45% per visit (2 hours 36 minutes ± 1 hour 4 minutes v 4 hours ± 1 hour 4 minutes; P < .001). No safety issues were detected. Of the intervention group, 88% reported to be highly satisfied with the OHH model, and 77% reported a positive impact on their QoL. At study end, 60% of both study arms preferred OHH above SOC. CONCLUSION The shift of particular procedures from the outpatient clinic to the patients' homes offers a high-quality and patient-centered alternative for a large proportion of patients with cancer. Further research is needed to evaluate potential cost-efficiency.

Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Haider Warraich ◽  
Salim Virani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Care Providers ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care ◽  
Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

scholarly journals Ambulatory Surgical Centers: Improving Quality of Operative Spine Care?

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 29S-35S ◽  
Author(s):  
Christopher D. Witiw ◽  
Jefferson R. Wilson ◽  
Michael G. Fehlings ◽  
Vincent C. Traynelis
Keyword(s):  
Health Care Providers ◽  
Spine Surgery ◽  
Cost Optimization ◽  
Safety Data ◽  
Case Series ◽  
Surgical Care ◽  
Narrative Review ◽  
Care Providers ◽  
Ambulatory Surgical Centers

Study Design: Narrative review with commentary. Objective: Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety. Methods: This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting. Results: The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of “outpatient.” Conclusions: ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.

scholarly journals Assessment of Construct Validity of a Tool to Measure the Quality of Brief Advice for Dietary Sodium Reduction by Health Care Providers (P16-056-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Katherine Jefferson ◽  
Amber Armstrong-Izzard ◽  
JoAnne Arcand
Keyword(s):  
Health Care ◽  
Construct Validity ◽  
Health Care Providers ◽  
Dietary Sodium ◽  
Care Providers ◽  
Sodium Reduction ◽  
High Quality ◽  
Brief Advice ◽  
Advice Group

Abstract Objectives To test the construct validity of the Sodium Advice Score (SAS). The SAS is a tool developed to measure the quality of brief advice provided by health care providers (HCP) about dietary sodium reduction. The validation of this tool will support its implementation in a behavioural intervention trial. Methods Thirty English speaking patients with a diagnosis of hypertension and no memory impairments were recruited from a primary care clinic in Ontario, Canada. Patients were randomized to a high quality dietary sodium advice group or to a low quality dietary sodium advice group. Each intervention was delivered by a registered dietitian and took no longer than 5–7 minutes for high quality advice and 1–2 minutes for low quality advice. After the dietary sodium advice was provided the patient completed the SAS tool (< 5 minutes). Frequency, type and duration of advice was assessed by the SAS tool, which had a maximum score of 16. Therefore, the high quality advice had an expected SAS score of 16. The low quality advice had an expected SAS score of 5. Results Patients included were 71.3 ± 7.9 years old and 53% were male. Overall, 43% and 47% of patients had received previous counseling from a dietitian and family doctor, respectively. Mean daily sodium intakes of 2593 ± 1403 mg/day and 3040 ± 2283 mg/day were similar between high and low quality advice groups. The mean SAS score was 6.9 ± 3.6 (range: 2 to 14) in the low quality advice group and 14.5 ± 1.5 (range: 10 to 16) in the high quality advice group. The high quality advice scores observed were statistically similar to the expected scores (P = 0.001), however the low advice scores were not. Overall, the low quality advice score was significantly lower than the high quality advice score (P < 0.000). Conclusions The SAS tool showed evidence of construct validity as it can differentiate between high and low quality sodium reduction advice provided by HCPs. It can be used as a valid tool for measuring quality of brief sodium reduction advice by HCPs in future research. Funding Sources Heart and Stroke Foundation of Canada.

scholarly journals Unmet needs and recommendations to improve meningioma care through patient, partner, and health care provider input: a mixed-method study

2019 ◽  
Author(s):  
Amir H Zamanipoor Najafabadi ◽  
Johannes P M van de Mortel ◽  
Daniel J Lobatto ◽  
Dieta R Brandsma ◽  
Wilco C Peul ◽  
...  
Keyword(s):  
Health Care ◽  
Focus Groups ◽  
Health Care Providers ◽  
Unmet Needs ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Theory Approach ◽  
Care Providers ◽  
Patient Centered ◽  
Patient Reported

Abstract Background It has been suggested that lack of ongoing registration of patient-centered outcomes has resulted in existing care trajectories that have not been optimized for sequelae experienced by meningioma patients. This study aimed to evaluate the structure of current meningioma care and identify issues and potential high-impact improvement initiatives. Methods Using the grounded theory approach, a thematic framework was constructed based on the Dutch Comprehensive Cancer Organisation survey about issues in meningioma care trajectories. This framework was used during 3 semistructured interviews and 2 focus groups with patient-partner dyads (n = 16 participants), and 2 focus groups with health care providers (n = 11 participants) to assess issues in current meningioma care trajectories and possible solutions, including barriers to and facilitators for implementation. Results Identified issues (n = 18 issues) were categorized into 3 themes: availability and provision of information, care and support, and screening for (neurocognitive) rehabilitation. A lack of information about the intervention and possible outcomes or complications, lack of support after treatment focusing on bodily and psychological functions, and reintegration into society were considered most important. Sixteen solutions were suggested, such as appointment of case managers (solution for 11/18 issues, 61%), assessment and treatment by physiatrists (22%), and routine use of patient-reported outcome measures for patient monitoring (17%). Barriers for these solutions were lack of budget, capacity, technology infrastructure, and qualified personnel with knowledge about issues experienced by meningioma patients. Conclusions This study identified issues in current multidisciplinary meningioma care that are considered unmet needs by patients, partners, and health care providers and could guide innovation of care.

scholarly journals Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis

2019 ◽  
Vol 23 (5_suppl) ◽  
pp. 3S-11S ◽  
Author(s):  
Irene Lara-Corrales ◽  
James N. Bergman ◽  
Ian Landells ◽  
Michele L. Ramien ◽  
Perla Lansang
Keyword(s):  
Atopic Dermatitis ◽  
Health Care Providers ◽  
Patient Reported Outcomes ◽  
Assessment Tools ◽  
Care Providers ◽  
Patient Counseling ◽  
Consensus Document ◽  
Subjective Assessments ◽  
Patient Reported

Pediatric atopic dermatitis (AD) is one of the most common dermatoses encountered by health-care providers treating children. Diagnosis of AD is clinical, with no universally accepted biomarkers or assessment tools. Patient-reported outcomes and subjective assessments of quality of life in both the patient and family are important considerations when treating pediatric AD. Here, we provide an overview of pediatric AD epidemiology, its clinical presentation, burden, diagnosis, and assessment, with a focus on implications for patient counseling in order to optimize care.

Article Commentary: Explaining the Shift to Value-Based Reimbursement in the Setting of Dermatology and Psoriasis

2016 ◽  
Vol 2 (1) ◽  
pp. 5-8
Author(s):  
Benjamin Farahnik ◽  
Mio Nakamura ◽  
Tina Bhutani ◽  
John Koo
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Skin Diseases ◽  
Fee For Service ◽  
Care Providers ◽  
Quality Reporting ◽  
Physician Participation ◽  
Patient Reported ◽  
Physician Quality Reporting System

The Department of Health and Human Services has announced a campaign for transitioning Medicare reimbursement from volume to value. A budget-neutral Value-Based Payment Modifier has been implemented that provides for differential payment to physicians based upon the quality of care delivered. The value modifier will be based partially on physician participation in the Physician Quality Reporting System (PQRS), which allows for reporting of information on quality of care to Medicare. The information reported includes both medical data and patient-reported experiences with health care providers. Starting in 2017, the value modifier payment adjustment will apply to all physicians who make Medicare part B fee-for-service charge claims. Physicians who do not participate in the PQRS and satisfy reporting requirements may be assessed negative adjustments to their payments. Dermatologists in particular will be impacted by these changes, as skin diseases, especially psoriasis, account for a significant economic burden in the U.S.

Is routine administration of standardized questionnaires that assess aspects of patients’ quality of life justified in medical oncology clinics?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20501-e20501
Author(s):  
Khalid A. Al-Saleh
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Care Providers ◽  
Randomized Controlled ◽  
Use Of Resources ◽  
Routine Administration

e20501 Background: increasing interest in the Quality of Life outcomes in cancer patients led to increase implementation of their use in routine clinical practice. The aim of this study is to review the scientific evidence behind recommending the use of quality of life (QoL) scales routinely in outpatient evaluation. Methods: systematic review for all published randomized controlled trials in English language between January 1, 1990 till December 1, 2010. Out of 479 articles (468 identified by electronic search + 11 articles identified by manual search), six trials satisfied the eligibility criteria: 1) the study was a randomized controlled trial (RCT) with randomization of patients or health care providers; 2) the findings of the administered questionnaire or scale (the intervention) were given to health care provider, and compared to standard care with no questionnaire administered (the control); 3) study was conducted in outpatient oncology clinics; and 4) an outcome was measured that related to i) QoL improvement, ii) reduction in morbidity, iii) reduction in stress for the patients, iv) improvement in communication between patients and health care provider, or v) improved patient satisfaction. Assessment for the quality of the study was done using the GRADE methodology. Results: serious methodological issues were affecting most of the trials. Overall the evaluation of the quality of the evidence from these identified trials suggests that there is a weak recommendation to use QoL scales in routine oncology practice to improve communication between physicians and patients. Conclusions: The routine use of such tools in the outpatient settings at improving the patient outcome or satisfaction cannot be recommended based on the available evidence. The potential harm with the excess use of resources needed to implement, collect, store, analyse, and present such data to health care providers should be also considered. Further research and better designed trials is required using recent methodological techniques (such as item-response theory based questionnaire and cluster randomization) might help to reach an answer to this question.

Quality of life in palliative care: principles and practice

2015 ◽  
Author(s):  
Stein Kaasa ◽  
Jon Håvard Loge
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Research Question ◽  
Patient Reported Outcome ◽  
Care Providers ◽  
Sequential Approach ◽  
Patient Reported

To improve or sustain patients’ health-related quality of life (HRQOL) is the main goal of palliative care. In health care, HRQOL encompasses a range of components that are measurable and related to health, disease, illness, and medical interventions. Another term, patient-reported outcome (PRO), is used and understood as any measure that collects responses directly from the patients and measures any aspect of patients’ health status that is reported by the patients without any interpretation by health-care providers or family members. The selection of PRO-instruments (questionnaires) is recommended to follow a sequential approach. Define overall aim(s), define the research question(s), agree upon the key outcome(s), and select the appropriate set of questions/questionnaires guided by the primary and secondary outcomes. In general, it is recommended to use a HRQOL measure of generic or disease-specific character and supplement it with domain-specific measure(s) (such as measurement of fatigue, pain, anxiety, depression, etc.) reflecting the purpose(s) of the data collection.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

Sign in / Sign up

Export Citation Format

Share Document