Telehospice: Implementation lessons from rural hospice care with mobile tablets.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6546-6546
Author(s):  
Gary C. Doolittle ◽  
Eve-Lynn Nelson ◽  
Ashley Spaulding ◽  
Sandy Kuhlman
Keyword(s):  
Rural Communities ◽  
Family Support ◽  
Hospice Care ◽  
Medical Center ◽  
Cost Effective ◽  
Academic Community ◽  
Lessons Learned ◽  
Ease Of Use ◽  
Comfort Level ◽  
Hospice Nurses

6546 Background: In underserved rural communities, hospice personnel often travel great distances to reach patients, resulting in challenges to maintain access, quality, cost-effectiveness and safety. To address these disparities, the University of Kansas Medical Center piloted the country’s first TeleHospice (TH) service in 1998. Barriers such as technology limitations, costs and attitudes towards technology limited adoption (Cook et al., 2001). An updated academic-community project utilizes secure mobile videoconferencing to support TH services in Kansas’ frontier communities. Methods: Leveraging lessons learned from the early work, a secure cloud-based videoconferencing solution was chosen for ease of use. To maximize limited resources, the selection of hospice partners was guided by Gustafson et al.’s (2003) Organizational Change Manager, which also informed implementation gaps. The academic team partnered with Hospice Services, Inc., a leader in rural hospice care, providing services to 16 Kansas counties. Results: From February 2016 through January 2017, 116 TH encounters occurred, encompassing 707 attendees over 7,462 minutes. The most common TH uses to date have been: administrative (e.g., connecting hospice staff across 16 counties); professional-to-professional (e.g., connecting hospice nurses at homes to additional TH professionals); and family support (e.g., connecting adult children with loved ones). Initial use of videoconferencing for administrative purposes developed a comfort level in using it for clinical and family support purposes. For staff meetings alone, the hospice has saved approximately $2,500/month in travel, with TH staff noting increased morale driven by increased team communication. Conclusions: Compared with early work, technology advances and a community-centered approach have increased TH adoption. With decreasing budgets as well as rural hospice closures, innovative, cost-effective and community-driven approaches such as TH are needed to decrease disparities. As dissemination occurs in national hospice organizations, continued research is needed to understand best fit within frontier hospices, to inform future urban applications and to address reimbursement.

TeleHospice: A Community-Engaged Model for Utilizing Mobile Tablets to Enhance Rural Hospice Care

2019 ◽  
Vol 36 (9) ◽  
pp. 795-800 ◽  
Author(s):  
Gary C. Doolittle ◽  
Eve-Lynn Nelson ◽  
Ashley O. Spaulding ◽  
Adam F. Lomenick ◽  
Hope M. Krebill ◽  
...  
Keyword(s):  
Rural Communities ◽  
Hospice Care ◽  
Medical Center ◽  
Cost Effective ◽  
Ease Of Use ◽  
Direct Patient Care ◽  
University Of Kansas ◽  
The University ◽  
Mobile Tablets ◽  
Kansas Medical

Background: In rural communities, providing hospice care can be a challenge. Hospice personnel sometimes travel great distances to reach patients, resulting in difficulty maintaining access, quality, cost-effectiveness, and safety. In 1998, the University of Kansas Medical Center piloted the country’s first TeleHospice (TH) service. At that time, challenges with broad adoption due to cost and attitudes regarding technology were noted. A second TH project was launched in early 2017 using newer technology; this article updates that ongoing implementation. Methods: The Organizational Change Manager was followed for the guided selection of the hospice partner. The University of Kansas Medical Center partnered with Hospice Services, Inc. (HSI), a leader in rural hospice care, providing services to 16 Kansas counties. Along with mobile tablets, a secure cloud-based videoconferencing solution was chosen for ease of use. Results: From August 2017 through January 2018, 218 TH videoconferencing encounters including 917 attendees occurred. Calls were made for direct patient care, family support, and administrative purposes. These TH calls have been shown to save HSI money, and initial reports suggest they may strengthen the communication and relationships between staff, patients, and the patient’s family. Conclusion: Finding innovative, cost-effective, and community-driven approaches such as TH are needed to continually advance hospice care. TeleHospice’s potential to supplement and improve hospice services while reducing costs is significant, but continued research is needed to understand best fit within frontier hospices, to inform future urban applications, and to address reimbursement.

scholarly journals Implementation of point-of-use water treatment methods in a rural Tanzanian community: a case study

2020 ◽  
Vol 10 (4) ◽  
pp. 1012-1018
Author(s):  
T. M. Ngasala ◽  
S. J. Masten ◽  
C. Cohen ◽  
D. Ravitz ◽  
E. J. Mwita
Keyword(s):  
Water Treatment ◽  
Rural Communities ◽  
Water Samples ◽  
Cost Effective ◽  
Ease Of Use ◽  
Water Disinfection ◽  
Coliform Bacteria ◽  
Treatment Methods ◽  
Point Of Use ◽  
Household Water

Abstract This study was conducted in an agro-pastoral community in Northern Tanzania, where water sources are contaminated, and point-of-use water treatment is rarely used. The objectives of the study were to determine the quality of drinking water at the household level and to assess the perception and attitude towards the treatment methods that were introduced to community members. The three treatment methods evaluated were chlorine tablets, silver-infused ceramic tablets, and solar water disinfection (SODIS). These methods were selected due to their availability, ease of use, cost, and effectiveness in water with high levels of coliform bacteria. Each home within the study area was provided with one of three treatment methods. The use, performance, and acceptability of the new water treatment methods were assessed over a three-week period. Prior to the introduction of the methods, 40% of households reported that they treated water regularly. However, 80% of the household water samples tested positive for Escherichia coli. After introducing the new methods, 60% of households increased their water consumption, and all water samples tested negative for E. coli during the final week of testing. The work demonstrates the need to provide access to cost-effective household water treatment methods, especially in rural communities that lack access to potable water.

Racial and social disparities on aggressiveness of end-of-life cancer care in a rural academic center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18063-e18063
Author(s):  
Praveen Namireddy ◽  
Shravanti Macherla ◽  
James Thompson McClain ◽  
Mahvish Muzaffar
Keyword(s):  
End Of Life ◽  
Family Support ◽  
Cancer Care ◽  
Hospice Care ◽  
Hospital Admissions ◽  
Medical Center ◽  
Composite Score ◽  
Minority Population ◽  
Icu Admission ◽  
Ed Visits

e18063 Background: Aggressive cancer care at the end of life (EOL) can impact quality of life and have major economic burden. The purpose of this study was to determine the aggressiveness of EOL cancer care, and its relation to race, gender and social factors in Eastern North Carolina with a high rural and minority population. Methods: This is a retrospective analysis of 401 stage 4 solid tumor patients who died between 2011 and 2014 at Vidant Medical Center. Aggressiveness of care was calculated by a composite score adopted from Earle et al. Scores range from 0 to 7 with higher scores indicating more aggressive EOL care. 1 point was given to each indicator of aggressiveness in the last 30 days of life: ED visits ≥2, hospital admissions ≥2, any ICU admission, hospitalized days ≥14, new chemotherapy, hospice care ≤ 3 days, and any chemotherapy in the last 14 days. Results: Among 401 patients, 217 (54%) were white and 178 (44%) were black. The mean composite score for aggressiveness (CSA) for whites was 1.18 and for blacks it was 1.87 (p<0.001). In the last 30 days of life, a higher proportion of blacks had ≥ 2 ED visits 28% vs 13%(p<.0001), ≥ 2 hospital admission 23% vs 13%(p=0.001), any ICU admission 29% vs 16%(p=0.0002), chemotherapy in the last 14 days 30% vs 20%(p=0.001), and ≥ 14 hospitalized days 35% vs 21%(p<0.001) compared to whites. More whites were enrolled in hospice compared to blacks 53% vs 45% (p<0.001). Correlation analysis using Fit Y by X model showed statistically significant differences between CSA (score ≤ 3 and >3) and other variables such as whites vs blacks p <0.001, females vs males p=0.0006, not married vs married p<0.0001, and no family support vs family support p<0.0001. Conclusions: Male, unmarried and black patients were associated with higher CSA. Patients who were white, married and with family support had higher likelihood of enrolling in hospice. [Table: see text]

scholarly journals ACCESS TO CARE ROUNDS: A UNIQUE FORUM FOSTERING HEALTH SYSTEM AND SOCIAL SERVICE PARTNERSHIPS FOR OLDER VETERANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S496-S496
Author(s):  
Kathryn A Nearing ◽  
Hillary D Lum ◽  
Heather Kamper ◽  
Kaily A Cannizzaro ◽  
Courtney Bauers ◽  
...  
Keyword(s):  
Access To Care ◽  
Social Services ◽  
Hospice Care ◽  
Medical Center ◽  
Rocky Mountain ◽  
Lessons Learned ◽  
Integrated Networks ◽  
Complex Needs ◽  
Home Based ◽  
Session Evaluations

Abstract Colorado Veteran Community Partnership (VCP) aims to connect Rocky Mountain Regional VA Medical Center front-line teams with diverse community partners to create integrated networks of support for older Veterans with complex needs and their family members and caregivers. To accomplish this goal, VCP launched Access to Care Rounds in January 2018 to build bridges between the healthcare system and community-based organizations. Each Access to Care Rounds features a cross-sector panel that discusses specific efforts to link a medically-complex, older Veteran to resources. This model was developed with stakeholder input and has highlighted topics related to chronic pain management, suicide prevention, homelessness, adult protective services, transportation, home-based primary care, hospice care, and firearm safety. Each Access to Care Rounds focuses on connecting VCP members, sharing expertise and resources, and highlights lessons learned related to care coordination, communication, and key processes that others can adopt/adapt to better serve older Veterans. On average, 30 individuals attend each session. Access to Care Rounds draw diverse audiences representing social services, mental health and other healthcare specialties. The latter include Social Workers (47%), Physicians (11%), Psychologists (8%), Registered Nurses (6%), and students/trainees (6%). Participants receive a description of the Veteran situation; the names, credentials, organizational affiliations and roles/expertise of each panelist; and, a resource list relevant to the constellation of issues addressed to enhance access to information and resources. Over 38% of respondents to session evaluations reported intentions to change their professional practice as a result of what they learned during an Access to Care Rounds.

scholarly journals The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

2021 ◽  
pp. 1-15
Author(s):  
Kevin Hauck ◽  
Katherine Hochman ◽  
Mark Pochapin ◽  
Sondra Zabar ◽  
Jeffrey A Wilhite ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Medical Center ◽  
The United States ◽  
Lessons Learned ◽  
Front Line ◽  
Clinical Leadership ◽  
Team Members ◽  
Medical Centers ◽  
Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

scholarly journals Food Security, Environmental Health, and the Economy in Mexico: Lessons Learned with the COVID-19

2021 ◽  
Vol 13 (13) ◽  
pp. 7470
Author(s):  
Rebeca Monroy-Torres ◽  
Ángela Castillo-Chávez ◽  
Erika Carcaño-Valencia ◽  
Marco Hernández-Luna ◽  
Alex Caldera-Ortega ◽  
...  
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Environmental Health ◽  
Public Policies ◽  
Cost Effective ◽  
Lessons Learned ◽  
Civil Society Organizations ◽  
Human Right ◽  
Healthy Environment ◽  
Mesh Terms

The COVID-19 pandemic showed an impact mainly on the health of people and the economy of households. The levels of food security in the world’s households, especially in Mexico, have decreased. When people do not have food security, their health is compromised and they have financial problems; on the other hand, environmental deterioration has a link with food security. The purpose of this review is to analysis of the current situation in Mexico of food security, environmental health and economy, the main lessons learned in these areas and their proposals integrating public policies. A review was carried out in the main databases (MEDLINE, Embase, CINAHL Plus, Web of Science, CAB Abstracts y PAIS Index) with the following keywords and according to the MeSH terms: Food security, food insecurity, environmental health, public policies, environmental, production, integrating the word COVID-19 in English and Spanish. Only 44.5% of Mexican households presented food security. For food insecurity, 22.6% had moderate and severe food insecurity, while 32.9% had mild insecurity. Food insecurity and the health impacts of environmental origin (waste management during the coronavirus pandemic, water contaminated by bacteria, viruses, and toxins; air pollution) generates impacts on economic activity by not offering food that meets health regulations. Without the application of cost-effective measures and interventions for the prevention and control of patients with obesity, the direct costs for 2023 will amount to 9 million dollars, which worsens the household economy. Despite having laws and policies on the right to food, a healthy environment (water), and opportunities for economic growth, these human rights are not fulfilled. The conclusion is that it is necessary to use a health and agroecological model to promote public policies (health, environment, and economy) that aims to prevent the discussed issues, with multidisciplinary and intersectoral interventions (government, academia, researchers, civil society organizations, industry, and population). This upholds the human right that all people should enjoy an adequate, healthy environment and have access to high-quality food.

scholarly journals Conceptualization and Realization of a National Trail in a Small Island-Nation: The Commonwealth of Dominica’s Experience

2021 ◽  
Vol 2 (1) ◽  
pp. 79-94
Author(s):  
Colmore S. Christian
Keyword(s):  
Rural Communities ◽  
Socioeconomic Development ◽  
Research Question ◽  
Strong Support ◽  
Lessons Learned ◽  
Small Island ◽  
Implementation Challenges ◽  
Face To Face ◽  
Research Themes ◽  
Socioeconomic Benefits

The island-nation of Dominica, 790 km2 in area, is located approximately 1126.5 km Southeast of Florida, USA. In the mid-1990s, Dominica embarked on developing the 183.5 km Waitukubuli National Trail (WNT), the first and only national trail model in the Eastern Caribbean. The 14-segment WNT, officially opened in May 2013, passes through some of the island’s most diverse landscapes. WNT was designed to link as many rural communities as possible and promote ecotourism and community socioeconomic development. Rehabilitation work continues on the WNT and the rest of Dominica, following the devastation caused by Hurricane Maria of 2017. This article, based primarily on a limited questionnaire survey, selected interviews, and literature review, explored the research question ‘What were the challenges faced by a small-island nation in the development of a National Trail? Five specific research objectives focused on the conceptualization, implementation challenges, partnerships fostered, national and sub-regional significance, and future outlook of the Trail were considered. Questionnaire respondents identified the island’s topography and negotiations with private landowners as significant trail construction challenges. A 100% of survey respondents anticipate that reliable funding to support timely maintenance would likely be a critical future issue. Some respondents identified marketing, public engagement, and visitor safety as potential issues. Face-to-face interviews found strong support for the WNT. The interviewees were confident that Dominica would realize sustainable socioeconomic benefits from the Trail. The article concludes with lessons learned and proposes strategies and research themes to ensure the Trail’s sustainability.

scholarly journals Exploring the Critical Factors, the Online Learning Continuance Usage during COVID-19 Pandemic

2021 ◽  
Vol 13 (10) ◽  
pp. 5471
Author(s):  
Chuan-Yu Mo ◽  
Te-Hsin Hsieh ◽  
Chien-Liang Lin ◽  
Yuan Qin Jin ◽  
Yu-Sheng Su
Keyword(s):  
Online Learning ◽  
Technology Acceptance ◽  
Family Support ◽  
Technology Acceptance Model ◽  
Online Teaching ◽  
Ease Of Use ◽  
Critical Factors ◽  
Factors Affecting ◽  
E Learning ◽  
Acceptance Model

In order to enable online learning to continue developing when the COVID-19 pandemic passes, this study aimed to identify the critical factors that affected the use of e-learning by university students during the pandemic. These critical factors will help to increase the efficiency of future development and deployment of online learning systems. Through a literature review, this study employed the technology acceptance model, social support, and task–technology fit as the theoretical basis to establish the framework of the online learning environment with regards to the technology acceptance model in the context of emergency management. A questionnaire survey was administered to students in universities that had implemented online teaching during the pandemic, and 552 valid responses were collected. The survey explored the factors affecting the willingness of higher education institution students to continue using online learning, and the following conclusions were drawn. (1) The easier an online learning platform was to navigate, the better it was perceived by the students, and thus the students were more willing to use it. (2) Ease of use and usefulness were associated with the teachers’ choice of platform and their ability to achieve a satisfactory fit between the course design and platform navigation, which thereby affected the students’ learning outcomes and attitude towards use. (3) The positive attitude of teachers towards teaching increased the students’ perceived ease of use of online learning. (4) During the pandemic, family support—a major support for teachers in online teaching—enhanced teachers’ attitudes towards, and willingness to provide, online teaching. A high level of support showed that the parents urged the students to learn and complete online learning tasks as instructed by the teachers, implying that family support could affect the students’ habits towards, adaptation to, and identification of online learning. The study results provide insights into the factors affecting the willingness of teachers and students to continue using e-learning platforms.

scholarly journals Integrating a Sport-Based Trauma-Sensitive Program in a National Youth-Serving Organization

2021 ◽  
Author(s):  
M. Shaikh ◽  
C. Bean ◽  
L. Bergholz ◽  
M. Rojas ◽  
M. Ali ◽  
...  
Keyword(s):  
Program Development ◽  
Program Implementation ◽  
Effective Means ◽  
Academic Community ◽  
Lessons Learned ◽  
Community Context ◽  
Research Approach ◽  
Prevention Measures ◽  
Action Research Approach ◽  
Interdisciplinary Partnership

AbstractThere is a pressing need to equip youth-serving community organizations to respond to the unique needs of trauma-exposed children. Early prevention measures can be an effective means of redirecting children to self-regulatory healing, while facilitating their transition toward strength-based thriving. Sport can offer a powerful opportunity to reach these children; however there remains little information on how to effectively develop, deliver, evaluate, and sustain trauma-sensitive sport programs in a community context. The purpose of this paper is to outline a case study of integrating sport-based trauma-sensitive practices with BGC Canada’s national Bounce Back League program. An interdisciplinary partnership of academic, community, and practice experts used a community-based participatory action research approach, paired with a knowledge translational approach, to guide the process of program development. Mixed methods (e.g., surveys, logbooks, interviews, focus groups, online communications) were used to generate ongoing insights of staff’s training experiences, successes and challenges of program implementation, and potential impact of program on club members. Several stages of program development are described, including: (a) collaboratively planning the program; (b) piloting the program to three clubs; (c) adapting the program using pilot insights; (d) expanding the adapted program to ten clubs; and (e) creating opportunities to maintain, sustain, and scale-out practices throughout grant duration and beyond. Lessons learned regarding the leadership team’s experiences in terms of developing, adapting, and integrating trauma-sensitive practices in this community context are shared.

Sign in / Sign up

Export Citation Format

Share Document