Measurement of person-centered care delivery of adult oncology in Ontario, Canada.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 223-223 ◽  
Author(s):  
Lesley Moody ◽  
Erica Bridge ◽  
Suman Dhanju ◽  
Brett Nicholls ◽  
Simron Singh
Keyword(s):  
Literature Review ◽  
Focus Groups ◽  
Best Practice ◽  
Assessment Tool ◽  
Care Delivery ◽  
Guideline Implementation ◽  
Healthcare Providers ◽  
Daily Practice ◽  
Modified Delphi ◽  
Strongly Agree

223 Background: In the Ontario, Canada, cancer system, the provincially endorsed Person Centred Care (PCC) Guideline provides recommendations for healthcare providers to implement PCC in the delivery of adult oncology services. However, it is unknown whether healthcare providers have incorporated these recommendations into their daily practice within the Regional Cancer Programs (RCPs). The purpose of this study was to develop an assessment tool to evaluate the implementation of the PCC Guideline in Ontario RCPs. Methods: Tool development consisted of a 3-step process: 1) literature review to identify relevant measures, 2) Modified Delphi with a panel of experts (n = 8), and 3) focus groups with patient/family advisors (n = 5) and RCP PCC leads (i.e., designated individual responsible for PCC deliverables) (n = 7). Results: Through the literature review, two relevant tools were identified ( i.e., Institute for Patient- and Family-Centered Care’s Hospital Assessment Tool and Accreditation Canada’s Cancer Care Standards), resulting in 187 measures deemed appropriate to include in the assessment tool. In round one of the Modified Delphi, each measure was evaluated independently by a panel of experts using a 5-point Likert Scale (1 = strongly disagree to 5 = strongly agree) to assess both the importance and feasibility of each measure. Sixty-seven measures were rated 4 or above by 70% of the experts. Consistent with Modified Delphi best practice, these measures were discussed during the second round with the panel of experts. An additional 33 measures were removed due to similarities/duplications. Nine measures were added. The 42 measures were presented to patient/family advisors and the RCP PCC Leads during focus groups and evaluated based on importance and feasibility of assessing PCC implementation in the RCPs. Wording recommendations were made and two additional measures were added. The final tool includes 44 measures to evaluate PCC implementation within the RCPs. The assessment tool was disseminated to the 14 RCPs in October 2016. Conclusions: The results of this assessment will provide an understanding of the current state of PCC Guideline implementation in Ontario, in order to identify facilitators and barriers to implementation.

Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 1927-1928
Author(s):  
Giuseppe Boriani
Keyword(s):  
Clinical Skills ◽  
Care Delivery ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Cardiac Pacing ◽  
Daily Practice ◽  
Specific Patient ◽  
Current Prevalence ◽  
History Of ◽  
The Impact

The history of pacing for bradycardia started more than 50 years ago and in these five decades the technologically driven evolution of devices and tools has been complemented by the acquisition of important scientific evidence of benefit in specific patient settings. The current prevalence of bradyarrhythmias requiring permanent cardiac pacing therapy is not precisely known, but the progressive ageing of the population makes it necessary to improve knowledge of the impact of bradycardia on patients’ health, as well as to improve the implementation in daily practice of the most appropriate and evidence-based device treatments, with an adequate reorganization of care. Moreover, the impressive technological evolution that occurred in this field, as a result of extensive cooperation between physicians, scientists, engineers, manufacturers, regulatory agencies, and healthcare providers, led to the appearance of new requirements such as improved clinical skills, the need for continuous education on rapidly evolving technology, the assessment of treatment costs, the need for consensus guidelines, and the need for reorganization of care delivery including telemedicine for device follow-up.

scholarly journals Stakeholder Assessment of Evidence-Based Guideline Dissemination and Implementation in a Dental Group Practice

2020 ◽  
Vol 6 (1) ◽  
pp. 87-95
Author(s):  
I. Gruß ◽  
D.J. Pihlstrom ◽  
C.D. Kaplan ◽  
N. Yosuf ◽  
J.L. Fellows ◽  
...  
Keyword(s):  
Focus Groups ◽  
Clinical Guidelines ◽  
Resource Constraints ◽  
Care Delivery ◽  
Guideline Implementation ◽  
Implementation Process ◽  
Dissemination And Implementation ◽  
Fissure Sealant ◽  
Roles And Responsibilities ◽  
Pit And Fissure Sealant

Objective: This evaluation captures the perspectives of multiple stakeholders within a salaried dental care delivery organization (dentists, dental assistants, dental hygienists, and dental management) on the implementation of a pit-and-fissure sealant guideline in the Kaiser Permanente Dental Program. Also assessed is the role of formal processes and structures in providing a framework for guideline implementation. Methods: We collected qualitative data through field observations, stakeholder interviews (n = 6), and focus groups (30 participants in 5 focus groups). Field observation notes captured summaries of conversations and other activities. Interviews and focus groups were recorded and transcribed. We analyzed transcripts and field notes using a template analysis with NVivo 12 software to identify themes related to the existing implementation process of clinical guidelines and stakeholder perspectives on the strengths and weaknesses of this process. Results: Stakeholders perceived 2 main barriers for achieving implementation of the pit-and-fissure sealant guideline: 1) shortcomings in the implementation infrastructure resulting in lack of clarity about the roles and responsibilities in the guideline implementation process and lack of effective mechanisms to disseminate guideline content and 2) resource constraints, such as limited human, space, and material resources. Perceived opportunities for the dissemination and implementation of guidelines included recognition of the importance of guidelines in dental practice and well-functioning workflows within dental specialties. Conclusion: Our research points to the importance of developing and maintaining an infrastructure to ensure standardized, predictable mechanisms for implementation of guidelines and thereby promoting practice change. While addressing resource constraints may not be possible in all circumstances, an important step for improving guideline implementation—wherever feasible—would be the development of a robust implementation infrastructure that captures and delineates roles and responsibilities of different clinical actors in the guideline implementation process. Knowledge Transfer Statement: The results of this study can be used by health care leadership and administrators to understand possible reasons for a lack of guideline implementation and provide suggestions for establishing sustainable infrastructure to promote the adoption of clinical guidelines in salaried dental clinics.

scholarly journals An Educational Forum to Engage Infectious Diseases and Microbiology Residents in Resource Stewardship Modelled after the Choosing Wisely Campaign

2015 ◽  
Vol 26 (5) ◽  
pp. 231-233 ◽  
Author(s):  
Derek R MacFadden ◽  
Wayne L Gold ◽  
Ibrahim Al-Busaidi ◽  
Jeffrey D Craig ◽  
Dan Petrescu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Care Delivery ◽  
Daily Practice ◽  
Choosing Wisely ◽  
Delphi Panel ◽  
Potential Harm ◽  
Modified Delphi ◽  
Five Practices

BACKGROUND: Rising costs present a major threat to the sustainability of health care delivery. Resource stewardship is increasingly becoming an expected competency of physicians. The Choosing Wisely framework was used to introduce resource stewardship at a national educational retreat for infectious disease and microbiology residents.METHODS: During the 2014 Annual Canadian Infectious Disease and Microbiology Resident Retreat in Toronto, Ontario, infectious disease (n=50) and microbiology (n=17) residents representing 11 Canadian universities from six provinces, were invited to participate in a modified Delphi panel. Participants were asked, in advance of the retreat, to submit up to five practices that infectious disease and microbiology specialists should not routinely perform due to lack of proven benefit(s) and/or potential harm to patients. Submissions were discussed in small and large group forums using an iterative approach involving electronic polling until consensus was reached for five practices. A finalized list was created for both educational purposes and for residents to consider enacting; however, it was not intended to replace formal society-endorsed statements. A follow-up survey at two-months was conducted.RESULTS: Consensus was reached by the residents regarding five low-value practices within the purview of infectious diseases and microbiology physicians. After the retreat, 20 participants (32%) completed the follow-up survey. The majority of respondents (75%) believed that the session was at least as relevant as other sessions they attended at the retreat, including 95% indicating that at least some of the material discussed was new to them. Since returning to their home institutions, nine (45%) respondents have incorporated what they learned into their daily practice; four (20%) reported that they have considered initiating a project related to the session; and one (5%) reported having initiated a project.CONCLUSIONS: The present educational forum demonstrated that trainees can become actively engaged in the identification and discussion of low-value practices. Embedding residence training programs with resource stewardship education will be necessary to improve the value of care offered by the future members of our profession.

scholarly journals Evaluating the Linguistic Appropriateness and Cultural Sensitivity of a Self-Report System for Spanish-Speaking Patients with Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Cindy Tofthagen ◽  
Barbara Halpenny ◽  
Maribel Melendez ◽  
Laura Gonzalez ◽  
Veronica Sanchez Varela ◽  
...  
Keyword(s):  
Focus Groups ◽  
Cultural Sensitivity ◽  
Assessment Tool ◽  
Healthcare Providers ◽  
The United States ◽  
Spanish Speakers ◽  
Self Report ◽  
Spanish Version ◽  
Spanish Speaking ◽  
Sensitivity Assessment

Spanish speakers in the United States encounter numerous communication barriers during cancer treatment. Communication-focused interventions may help Spanish speakers communicate better with healthcare providers and manage symptoms and quality of life issues (SQOL). For this study, we developed a Spanish version of the electronic self-report assessment for cancer (ESRA-C), a web-based program that helps people with cancer report, track, and manage cancer-related SQOL. Four methods were used to evaluate the Spanish version. Focus groups and cognitive interviews were conducted with 51 Spanish-speaking individuals to elicit feedback. Readability was assessed using the Fry readability formula. The cultural sensitivity assessment tool was applied by three bilingual, bicultural reviewers. Revisions were made to personalize the introduction using a patient story and photos and to simplify language. Focus group participants endorsed changes to the program in a second round of focus groups. Cultural sensitivity of the program was scored unacceptable (x¯=3.0) for audiovisual material and acceptable (x¯=3.0) for written material. Fry reading levels ranged from 4th to 10th grade. Findings from this study provide several next steps to refine ESRA-C for Spanish speakers with cancer.

scholarly journals Closing the communication gap in neonatal inter-hospital transfer: a neonatal referral form for resource-limited settings - a modified e-Delphi-consensus study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 365
Author(s):  
Oscar Mwizerwa ◽  
Christian Umuhoza ◽  
Mark H. Corden ◽  
Tom Lissauer ◽  
Peter Thomas Cartledge
Keyword(s):  
Focus Groups ◽  
General Practitioners ◽  
Healthcare Providers ◽  
Clinical Information ◽  
Delphi Consensus ◽  
Resource Limited Settings ◽  
Modified Delphi ◽  
Resource Limited ◽  
District Hospitals ◽  
Hospital Transfer

Background: Standardised neonatal referral forms (NRFs) facilitate effective communication between healthcare providers and ensure continuity of care between facilities, which are essential for patient safety. We sought to determine the essential data items, or core clinical information (CCI), that should be conveyed for neonatal inter-hospital transfer in resource-limited settings (Rounds 1 to 3) and to create an NRF suitable for our setting (Round 4). Methods: We conducted an international, four-round, modified Delphi-consensus study. Round-1 was a literature and internet search to identify existing NRFs. In Round-2 and -3, participants were Rwandan clinicians and international paediatric healthcare practitioners who had worked in Rwanda in the five years before the study. These participants evaluated the draft items and proposed additional items to be included in an NRF. Round-4 focused on creating the NRF and used five focus groups of Rwandan general practitioners at district hospitals. Results: We identified 16 pre-existing NRFs containing 125 individual items. Of these, 91 items met the pre-defined consensus criteria for inclusion in Round-2. Only 33 items were present in more than 50% of the 16 NRFs, confirming the need for this consensus study. In Round-2, participants proposed 12 new items, six of which met the pre-defined consensus criteria. In Round-3, participants scored items for importance, and 57 items met the final consensus criteria. In Round-4, 29 general practitioners took part in five focus groups; a total of 16 modifications were utilised to finalise the NRF. Conclusions: We generated a novel, robust, NRF that may be readily employed in resource-limited settings to communicate the essential clinical information to accompany a neonate requiring inter-hospital transfer.

Development of best practices in the utilization and implementation of pediatric cervical spine traction: a modified Delphi study

2021 ◽  
pp. 1-12
Author(s):  
Nikita G. Alexiades ◽  
Belinda Shao ◽  
Bruno P. Braga ◽  
Christopher M. Bonfield ◽  
Douglas L. Brockmeyer ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Best Practices ◽  
Delphi Study ◽  
Best Practice ◽  
Pediatric Patients ◽  
Modified Delphi ◽  
Consensus Statements ◽  
Cervical Traction ◽  
Outcomes For Children ◽  
Strongly Agree

OBJECTIVE Cervical traction in pediatric patients is an uncommon but invaluable technique in the management of cervical trauma and deformity. Despite its utility, little empirical evidence exists to guide its implementation, with most practitioners employing custom or modified adult protocols. Expert-based best practices may improve the care of children undergoing cervical traction. In this study, the authors aimed to build consensus and establish best practices for the use of pediatric cervical traction in order to enhance its utilization, safety, and efficacy. METHODS A modified Delphi method was employed to try to identify areas of consensus regarding the utilization and implementation of pediatric cervical spine traction. A literature review of pediatric cervical traction was distributed electronically along with a survey of current practices to a group of 20 board-certified pediatric neurosurgeons and orthopedic surgeons with expertise in the pediatric cervical spine. Sixty statements were then formulated and distributed to the group. The results of the second survey were discussed during an in-person meeting leading to further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS After the initial round, consensus was achieved with 40 statements regarding the following topics: goals, indications, and contraindications of traction (12), pretraction imaging (6), practical application and initiation of various traction techniques (8), protocols in trauma and deformity patients (8), and management of traction-related complications (6). Following the second round, an additional 9 statements reached consensus related to goals/indications/contraindications of traction (4), related to initiation of traction (4), and related to complication management (1). All participants were willing to incorporate the consensus statements into their practice. CONCLUSIONS In an attempt to improve and standardize the use of cervical traction in pediatric patients, the authors have identified 49 best-practice recommendations, which were generated by reaching consensus among a multidisciplinary group of pediatric spine experts using a modified Delphi technique. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.

Developing a Charter of Spiritual Care for patients

2020 ◽  
Author(s):  
Akram Heidari ◽  
Abdolhasan Kazemi ◽  
Mohammad Abbasi ◽  
Seyed Hasan Adeli ◽  
Hoda Ahmari-Tehran ◽  
...  
Keyword(s):  
Literature Review ◽  
Delivery System ◽  
Expert Opinion ◽  
Systematic Literature Review ◽  
Spiritual Care ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Spiritual Needs ◽  
Healthcare Delivery System

Abstract Background Spirituality is recognized as an important issue in healthcare, and every individual has spiritual needs. Despite increased knowledge about spiritual care and its necessity, there is no unique agreed upon framework for spiritual care among the practitioners. This study aimed to explore the concept from the viewpoint of both healthcare providers and patients within the Iranian social, cultural and overall context and present a charter for providing spiritual care. Methods The study consisted of a systematic literature review, two qualitative studies on the components of spiritual care from the perspective of healthcare providers and its dimensions as perceived by patients. The findings were then integrated to make up a charter draft that was accredited through expert opinion. Results The review of literatures led to the identification of 2 main themes and 10 themes. Perspectives of healthcare providers were categorized into 4 main themes and 10 themes and patients’ opinions were classified into 3 main themes and 11 themes. The themes and their subthemes were integrated to build the concepts and form the proposed charter with 30 statements. Conclusion The charter of spiritual care for patients is intended to present an agreed upon framework for spiritual care delivery and resolve some of the problems in this path. This can improve healthcare delivery system.

scholarly journals DEVELOPING A PAIN IDENTIFICATION AND COMMUNICATION TOOLKIT FOR FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S719-S719
Author(s):  
Catherine Riffin ◽  
Karl Pillemer ◽  
Keela Herr ◽  
Emily Petti ◽  
Cary Reid
Keyword(s):  
Family Caregivers ◽  
Pain Assessment ◽  
Best Practice ◽  
Assessment Tool ◽  
Healthcare Providers ◽  
Field Testing ◽  
Community Dwelling ◽  
Best Practice Guidelines ◽  
Pain Communication ◽  
Pain Symptoms

Abstract Best practice guidelines have emphasized the importance of routine pain assessment of older persons with dementia (PWD), yet pain remains severely underdetected and undermanaged in this population. Training family caregivers in observational pain assessment and subsequent communication of the assessment results to a healthcare provider has the potential to help improve pain management among PWD. The goal of this presentation is to describe the approach to developing, refining, and pilot testing the Pain Identification and Communication Toolkit (PICT), a novel intervention to help family caregivers recognize pain symptoms in PWD and communicate those symptoms to healthcare providers. Guided by self-efficacy theory and empirical research on dementia and pain communication, this presentation will detail the approach to developing the PICT intervention manual and delineate its major components, including modules that prepare caregivers to: a) recognize and differentiate pain from dementia symptoms, b) administer an observational pain assessment tool, c) communicate effectively about pain symptoms, and d) plan steps to take when pain is detected. The presentation will report results from the process by which preliminary versions of the PICT manual were refined, including iterative field-testing with a sample of racially and ethnically diverse caregivers of community-dwelling PWD and healthcare providers. Results suggest that the development of PICT represents a useful step in addressing the underdetection and undermanagement of pain in PWD, and can pave the way for future intervention research on caregivers’ initiation of pain-related communication with healthcare providers.

scholarly journals Recommendations for determining the validity of consumer wearable heart rate devices: expert statement and checklist of the INTERLIVE Network

2021 ◽  
pp. bjsports-2020-103148
Author(s):  
Jan M Mühlen ◽  
Julie Stang ◽  
Esben Lykke Skovgaard ◽  
Pedro B Judice ◽  
Pablo Molina-Garcia ◽  
...  
Keyword(s):  
Heart Rate ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Best Practice ◽  
Healthcare Providers ◽  
Vital Signs ◽  
Well Being ◽  
Wearable Devices ◽  
Full Potential ◽  
Expert Opinions

Assessing vital signs such as heart rate (HR) by wearable devices in a lifestyle-related environment provides widespread opportunities for public health related research and applications. Commonly, consumer wearable devices assessing HR are based on photoplethysmography (PPG), where HR is determined by absorption and reflection of emitted light by the blood. However, methodological differences and shortcomings in the validation process hamper the comparability of the validity of various wearable devices assessing HR. Towards Intelligent Health and Well-Being: Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables assessing HR by PPG. The recommendations were developed through the following multi-stage process: (1) a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, (2) an unstructured review of the wider literature pertaining to factors that may introduce bias during the validation of these devices and (3) evidence-informed expert opinions of the INTERLIVE Network. A total of 44 articles were deemed eligible and retrieved through our systematic literature review. Based on these studies, a wider literature review and our evidence-informed expert opinions, we propose a validation framework with standardised recommendations using six domains: considerations for the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. As such, this paper presents recommendations to standardise the validity testing and reporting of PPG-based HR wearables used by consumers. Moreover, checklists are provided to guide the validation protocol development and reporting. This will ensure that manufacturers, consumers, healthcare providers and researchers use wearables safely and to its full potential.

scholarly journals Advancing the Development of Patient-reported Outcomes for Adult Myositis at OMERACT 2016: An International Delphi Study

2017 ◽  
Vol 44 (11) ◽  
pp. 1683-1687 ◽  
Author(s):  
Jin Kyun Park ◽  
Christopher A. Mecoli ◽  
Helene Alexanderson ◽  
Malin Regardt ◽  
Lisa Christopher-Stine ◽  
...  
Keyword(s):  
Focus Groups ◽  
Delphi Study ◽  
Patient Reported Outcomes ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
The United States ◽  
Delphi Survey ◽  
Modified Delphi ◽  
Patient Reported ◽  
Pharmaceutical Industries

Objective.To define a set of core patient-reported domains and respective instruments for use in idiopathic inflammatory myopathies (IIM). Previously, we reported a systematic literature review on patient-reported outcomes (PRO) in IIM followed by conducting international focus groups to elicit patient perspectives of myositis symptoms and effects.Methods.Based on qualitative content analysis of focus groups, an initial list of 26 candidate domains was constructed. We subsequently conducted an international modified Delphi survey to identify the importance of each of the 26 domains. Participants were asked to rate each domain on a scale of 0–10 (0 = not important, 10 = very important).Results.In this first round of the Delphi survey, 643 patients participated from the United States (n = 543), Sweden (n = 49), and South Korea (n = 51). Of the 26 domains, 19 (73%) were rated of high importance (≥ 7/10). The top 5 domains were muscle symptoms, fatigue, interactions with healthcare, medication side effects, and pain. During Outcome Measures in Rheumatology (OMERACT) 2016, we discussed the goal for ultimate reduction in the number of domains and the importance of considering representation of healthcare providers from other specialties, caregivers, representatives of pharmaceutical industries, and regulatory authorities in the next rounds of Delphi to represent broader perspectives on IIM.Conclusion.Further prioritization and a reduction in the number of domains will be needed for the next Delphi. At the next biennial OMERACT meeting, we aim to present and seek voting on a Myositis Preliminary PRO Core Set to enable ultimate measure selection and development.

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