scholarly journals Barriers to the Delivery of Timely, Guideline-Adherent Adjuvant Therapy Among Patients With Head and Neck Cancer

2020 ◽  
Vol 16 (12) ◽  
pp. e1417-e1432
Author(s):  
Evan M. Graboyes ◽  
Chanita Hughes Halbert ◽  
Hong Li ◽  
Graham W. Warren ◽  
Anthony J. Alberg ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck ◽  
Conceptual Model ◽  
Care Delivery ◽  
Care Transitions ◽  
Health Care Team ◽  
Organizational Level ◽  
Structured Interviews ◽  
Postoperative Radiation Therapy ◽  
Oncology Providers

PURPOSE: Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS: Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS: In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION: This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.

scholarly journals DENTAL HYGIENISTS AS ESSENTIAL MEMBERS OF THE HEALTH CARE TEAM

2018 ◽  
Vol 1 (2) ◽  
pp. 73
Author(s):  
Jacqueline Juhl
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Care Delivery ◽  
Cost Effective ◽  
Economic Loss ◽  
The United States ◽  
Health Care Team ◽  
Care Team ◽  
Oral Disease ◽  
Dental Hygienists

Despite the advances in dental sciences, innovative oral health programs, and efforts dedicated by oral health professionals,globally, unmet oral disease, and the economic loss it causes, is growing. In the present, oral health care delivery systemsurgently need improvement. The introduction of dental hygienists as essential members of the health care team can contributeto improved and cost-effective health care outcomes. This paper provides definitions of dental hygienists from both, aninternational and the United States (U.S.) and describes their education, functions, and contributions to the health care team.

Data Mining in Health Care Applications

Data Mining ◽  
2011 ◽  
pp. 350-365 ◽  
Author(s):  
Fay Cobb Payton
Keyword(s):  
Data Mining ◽  
Health Care ◽  
Care Delivery ◽  
Patient Data ◽  
Organizational Level ◽  
Privacy And Security ◽  
Political Issues ◽  
Health Care Applications ◽  
Community Data ◽  
The Individual

Recent attention has turned to the healthcare industry and its use of voluntary community health information network (CHIN) models for e-health and care delivery. This chapter suggests that competition, economic dimensions, political issues, and a group of enablers are the primary determinants of implementation success. Most critical to these implementations is the issue of data management and utilization. Thus, health care organizations are finding value as well as strategic applications to mining patient data, in general, and community data, in particular. While significant gains can be obtained and have been noted at the organizational level of analysis, much attention has been given to the individual, where the focal points have centered on privacy and security of patient data. While the privacy debate is a salient issue, data mining (DM) offers broader community-based gains that enable and improve healthcare forecasting, analyses, and visualization.

Tele-ICU Partners Enhance Evidence-Based Practice

2012 ◽  
Vol 23 (3) ◽  
pp. 312-322 ◽  
Author(s):  
Carol Olff ◽  
Cynthia Clark-Wadkins
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Care Delivery ◽  
Health Care Team ◽  
Evidence Based ◽  
New Members ◽  
Management Protocol ◽  
Information Research

Evidence-based practice (EBP) has become more than just a trendy buzzword in health care; EBP validates care delivery methods and grants satisfaction to nurses in knowing the care they provide is based on valid, current information. Research-based enhancements are paramount to the advancement of nursing practice and prompt the implementation of creative methods to improve care. The advent of the tele–intensive care unit (ICU) introduces new members of the health care team to assist with implementation of EBP initiatives. This new partnership results in improved length of stay, mortality rates, and ventilator times for critical care patients. Current literature suggests that a clinician-driven, standardized ventilator management protocol is of significant benefit. Tele-ICU clinicians provide an interactive element to coordinate interdisciplinary team efforts. Enhanced communication, data evaluation, and timely intervention expedite the weaning process and reduce ventilator length of stay. Consistent collaboration between tele-ICU and bedside clinicians successfully improves patient outcomes through standardized adherence to best-practice initiatives.

Perspectives on cancer care delivery from oncology patients who experienced unplanned acute care events.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 201-201
Author(s):  
Tara L. Kaufmann ◽  
Katharine A. Rendle ◽  
Erin Aakhus ◽  
Andrea Bilger ◽  
Peter Edward Gabriel ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Acute Care ◽  
Care Delivery ◽  
System Level ◽  
Self Management ◽  
Structured Interviews ◽  
Patient Factors ◽  
Management Interventions ◽  
High Level ◽  
Oncology Providers

201 Background: Unplanned acute care is debilitating and burdensome for patients with advanced cancer and their caregivers. There is a pressing need to understand how available evidence-based practices (EBPs) to reduce acute care 1) align with the needs and priorities of patients and 2) are best implemented within large health systems. We are conducting a mixed methods study to assess patient- provider- and system-level factors that shape the decision to seek acute care during active cancer treatment in order to select and adapt EBPs for implementation. Here we present data from patients’ perspectives. Methods: Purposive sampling approach to identify solid tumor cancer patients on active treatment with unplanned acute care events at a large health system from Aug 2018-Jan 2019. We conducted semi-structured interviews to elicit patients’ perspectives on factors that shape their decision to seek acute care and to inform intervention strategies. Results: Forty-nine patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ guilt for burdening their oncology team and to provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED, but do prefer in-person evaluation for new and distressing symptoms for safety. They express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care. Patients identify three areas for improvement: 1) enhanced peer support and education to manage uncertainty about cancer treatment; 2) accessible portals for patient-clinician communication; and 3) home or clinic-based after-hours oncology symptom management. Interventions to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.

scholarly journals Perceived Effects of a Somatic Psychopedagogy (SPP) Program in Nurse Training: An Exploratory Study

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Josée Lachance ◽  
Pierre Paillé ◽  
Jean-François Desbiens ◽  
Marianne Xhignesse
Keyword(s):  
Health Care ◽  
Sense Of Self ◽  
Health Care Team ◽  
The Body ◽  
Healthcare Team ◽  
Second Phase ◽  
Nurse Training ◽  
Structured Interviews ◽  
Care Giving

Background: Developed in Europe in the 1980’s, somatic psychopedagogy (SPP) is a formative practice geared toward care giving and support. Characterized as a type of mind-body medicine, it examines how the use of the body and its movement allows for the development of one’s conscience, one’s sense of self and of others, which are all desirable qualities for professionals within the health care sector.Purpose: To explore if and how SPP training followed by nurses modifies their perception of the quality of their self awareness, their presence in regard to others, as well as their relationship with respect to health and their professional practice.Methods: Qualitative research based on two types of semi-structured interviews: comprehensive and elicitation. Exploratory interviews with three nurses trained (or in training) in SPP. The content of the interviews was first analyzed thematically then grouped by categories.Findings: The three participants perceived a change in the quality of their presence with respect to themselves and to others as well as changes within the nature of their relationships with their patients, colleagues and healthcare team members. Content analysis of the interviews has allowed us to conclude that relationships with the health care team evolved into a better ability to give recognition and a better quality of interaction between members. Participants also reported an increased ability to express their opinions in both their personal and professional lives. A second level of analysis has allowed for the identification of differences between nurses just finishing their first year of training and those having completed the full four-year course.Conclusion: Interesting transformations are reported at different levels confirming the relevance of a second phase of the project. The latter will permit to identify whether physicians trained in SPP experience changes similar to those of the nurses, and if so, whether they perceive these as having an impact on their practice.

scholarly journals Perceptions, practice, and “ownership:” experiences in continuity of the patient-doctor relationship in a family medicine residency

2017 ◽  
Vol 8 (4) ◽  
pp. e74-85 ◽  
Author(s):  
Ann Lee ◽  
Sandra Kennett ◽  
Sheny Khera ◽  
Shelley Ross
Keyword(s):  
Health Care ◽  
Family Medicine ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Structured Interviews ◽  
Descriptive Research ◽  
Provider Experiences ◽  
Significant Barrier ◽  
Qualitative Descriptive ◽  
Constant Comparative Analysis

Background: The objective of this mixed-methods study was to determine interpersonal continuity (the ongoing therapeutic relationship between patient and health care provider) experiences of family medicine residents and preceptors, and explore their perceptions of interpersonal continuity.Methods: Quantitative data on resident and preceptor encounters were extracted from the electronic medical record (EMR). Opportunities for developing interpersonal continuity were determined using the Usual Provider Continuity (UPC) Index. A qualitative descriptive research method was used for the qualitative portion. Semi-structured interviews were conducted and constant comparative analysis was used to determine emerging themes.Results: Residents were found to have low UPC rates; preceptor rates were higher. Qualitative findings showed variable experiences with interpersonal continuity not apparent from UPC rates. Both preceptors and residents expressed perception of “ownership” of patients as a significant barrier to interpersonal continuity. Conclusion: This study suggests that a perceived lack of individual “ownership” of a patient panel was a significant barrier to developing interpersonal continuity. This might conflict with current changes towards team-based health care delivery. Understanding perceptions and changing them through a multi-faceted approach including resident teaching and faculty development might help improve interpersonal continuity which are core to both family medicine curricula and current models of health care delivery.

Multidisciplinary collaboration in primary care: through the eyes of patients

2013 ◽  
Vol 19 (3) ◽  
pp. 190 ◽  
Author(s):  
Lynn H. Cheong ◽  
Carol L. Armour ◽  
Sinthia Z. Bosnic-Anticevich
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Chronic Illness ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Primary Health Care System ◽  
Structured Interviews ◽  
Multidisciplinary Collaboration ◽  
Primary Health

Managing chronic illness is highly complex and the pathways to access health care for the patient are unpredictable and often unknown. While multidisciplinary care (MDC) arrangements are promoted in the Australian primary health care system, there is a paucity of research on multidisciplinary collaboration from patients’ perspectives. This exploratory study is the first to gain an understanding of the experiences, perceptions, attitudes and potential role of people with chronic illness (asthma) on the delivery of MDC in the Australian primary health care setting. In-depth semi-structured interviews were conducted with asthma patients from Sydney, Australia. Qualitative analysis of data indicates that patients are significant players in MDC and their perceptions of their chronic condition, perceived roles of health care professionals, and expectations of health care delivery, influence their participation and attitudes towards multidisciplinary services. Our research shows the challenges presented by patients in the delivery and establishment of multidisciplinary health care teams, and highlights the need to consider patients’ perspectives in the development of MDC models in primary care.

The Future is Now: The IMPACT of Regulatory and Health Care Reform on Speech-Language Pathology Practice - Part One

2016 ◽  
Vol 1 (15) ◽  
pp. 84-92
Author(s):  
Erin Knoepfel ◽  
Joanne Wisely
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Care Service ◽  
Health Care Service ◽  
Health Care Team ◽  
Motor Speech ◽  
The Future ◽  
Language Pathology ◽  
Key Events ◽  
The Impact

Throughout Parts 1 and 2 of this article, we will provide the knowledge and insight we have gained over the years, specific to this ever-changing health care arena. We will highlight key events that have shaped the American care delivery system and discuss current actions that lay the foundation for the future of the health care service environment. As professional members of the health care team, our goal is to ensure that we continue to provide high-quality services to those with communication, cognitive-communication, motor speech, voice, and swallowing impairments.

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Carolyn Foster ◽  
Dana Schinasi ◽  
Kristin Kan ◽  
Michelle Macy ◽  
Derek Wheeler ◽  
...  
Keyword(s):  
Health Care ◽  
Digital Literacy ◽  
Care Delivery ◽  
Digital Health ◽  
Health Care Team ◽  
Models Of Care ◽  
Health Data ◽  
Care Needs ◽  
Case Examples ◽  
Health Technologies

Remote patient monitoring (RPM) is a form of telemedicine that involves the collection and transmission of health data from a patient to their health care team by using digital health technologies. RPM can be leveraged to aggregate and visualize longitudinal patient-generated health data for proactive clinical management and engagement of the patient and family in a child’s health care. Collection of remote data has been considered standard of care for years in some chronic pediatric conditions. However, software limitations, gaps in access to the Internet and technology devices, digital literacy, insufficient reimbursement, and other challenges have prevented expansion of RPM in pediatric medicine on a wide scale. Recent technological advances in remote devices and software, coupled with a shift toward virtual models of care, have created a need to better understand how RPM can be leveraged in pediatrics to improve the health of more children, especially for children with special health care needs who are reliant on high-quality chronic disease management. In this article, we define RPM for the general pediatric health care provider audience, provide case examples of existing RPM models, discuss advantages of and limitations to RPM (including how data are collected, evaluated, and managed), and provide a list of current RPM resources for clinical practitioners. Finally, we propose considerations for expansion of this health care delivery approach for children, including clinical infrastructure, equitable access to digital health care, and necessary reimbursement. The overarching goal is to advance health for children by adapting RPM technologies as appropriate and beneficial for patients, families, and providers alike.

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