Addressing Transportation Insecurity Improves Attendance at Posthospitalization Appointments

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Sarah C. Hoffman ◽  
Amy S. Buczkowski ◽  
Leah Mallory ◽  
Lauren B. McGovern ◽  
Shannon M. Cappen ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Hospital Medicine ◽  
Primary Care Providers ◽  
Inpatient Stay ◽  
Care Providers ◽  
Pediatric Hospital ◽  
Discharge Instructions ◽  
Improvement Project ◽  
Interprofessional Team ◽  
Medicine Service

BACKGROUND: Transportation influences attendance at posthospitalization appointments (PHAs). In 2017, our pediatric hospital medicine group found that our patients missed 38% of their scheduled PHAs, with several being due to transportation insecurity. To address this, we implemented a quality improvement project to perform inpatient assessment of transportation insecurity and provide mitigation with the goal of improving attendance at PHAs. METHODS: The process measure was the percentage of patients with completed transportation insecurity screening, and the outcome measure was PHA attendance. An interprofessional team performed plan-do-study-act cycles. These included educating staff about the significance of transportation insecurity, its assessment, and documentation; embedding a list of local transportation resources in discharge instructions and coaching families on using these resources; notifying primary care providers of families with transportation insecurity; and auditing PHA attendance. RESULTS: Between July 2018 and December 2019, electronic health record documentation of transportation insecurity assessment among patients on the pediatric hospital medicine service and discharged from the hospital (n = 1731) increased from 1% to 94%, families identified with transportation insecurity increased from 1.2% to 5%, and attendance at PHAs improved for all patients (62%–81%) and for those with transportation insecurity (0%–57%). Our balance measure, proportion of discharges by 2 pm, remained steady at 53%. Plan-do-study-act cycles revealed that emphasizing PHA importance, educating staff about transportation insecurity, and helping families identify and learn to use transportation resources all contributed to improvement. CONCLUSIONS: Interventions implemented during the inpatient stay to assess for and mitigate transportation insecurity led to improvement in pediatric PHA attendance.

scholarly journals Development of a Cancer Care Summary Through the Electronic Health Record

2016 ◽  
Vol 12 (2) ◽  
pp. e231-e240 ◽  
Author(s):  
Laurie L. Carr ◽  
Pearlanne Zelarney ◽  
Sarah Meadows ◽  
Jeffrey A. Kern ◽  
M. Bronwyn Long ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Cancer Care ◽  
Query Language ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Health Record ◽  
Patient Portal ◽  
Care Providers ◽  
Improvement Project ◽  
Electronic Health

Introduction: Our objective was to improve communication concerning lung cancer patients by developing and distributing a Cancer Care Summary that would provide clinically useful information about the patient’s diagnosis and care to providers in diverse settings. Methods: We designed structured, electronic forms for the electronic health record (EHR), detailing tumor staging, classification, and treatment. To ensure completeness and accuracy of the information, we implemented a data quality cycle, composed of reports that are reviewed by oncology clinicians. The data from the EHR forms are extracted into a structured query language database system on a daily basis, from which the Summaries are derived. We conducted focus groups regarding the utility, format, and content of the Summary. Cancer Care Summaries are automatically generated 4 months after a patient’s date of diagnosis, then every 6 months for those receiving treatment, and on an as-needed basis for urgent care or hospital admission. Results: The product of our improvement project is the Cancer Care Summary. To date, 102 individual patient Summaries have been generated. These documents are automatically entered into the National Jewish Health (NJH) EHR, attached to correspondence to primary care providers, available to patients as electronic documents on the NJH patient portal, and faxed to emergency departments and admitting physicians on patient evaluation. Conclusion: We developed a sustainable tool to improve cancer care communication. The Cancer Care Summary integrates information from the EHR in a timely manner and distributes the information through multiple avenues.

scholarly journals One Institution - 2 Podcasts - Our experience

2019 ◽  
pp. 01-09
Author(s):  
Tony R Tarchichi ◽  
Jessica Garrison ◽  
Kishore Vellody
Keyword(s):  
Health Care ◽  
Down Syndrome ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Hospital Medicine ◽  
Care Providers ◽  
Pediatric Hospital ◽  
University Of Pittsburgh ◽  
The Subject ◽  
The University

Objectives: Podcasts have increased in popularity since the early 2000s. The number of medical podcasts created by physicians for patients and/or health care providers is increasing. With the increase in podcasts' popularity and their convenience, podcasts have significant potential for use as an educational tool. Methods: Faculty at the Children's Hospital of Pittsburgh of UPMC have created two podcasts, the Pediatric Hospital Medicine (PHM) podcast and the Down Syndrome Center (DSC) of Western Pennsylvania Podcast. This paper is a descriptive review of both podcasts. The PHM podcast was created for health care providers who care for hospitalized children. The DSC podcast was started as a source of reliable information for parents of children with Down syndrome. Results: The PHM podcast has over seventeen thousand downloads in over sixty-seven countries. The DSC podcast has over twenty-three thousand downloads in over sixty-nine countries. The PHM podcast has an option for listeners to get CME credit after they listen to the podcast if they click on a link at the University of Pittsburgh website and answer a few questions. Data from responses to these questions demonstrates that 83% of the respondents reported that the podcast either highly or very highly enhanced their knowledge of the subject matter, and 86.8% reported that the content of the podcast was highly or very highly relevant to their work. Conclusion: These results suggest podcasts are a popular and useful tool for disseminating information to families and health care professionals.

scholarly journals Patient Outcomes in a Pediatric Hospital Medicine Service Staffed With Physicians and Advanced Practice Providers

2019 ◽  
Vol 9 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Craig DeWolfe ◽  
Sarah Birch ◽  
Anne Callen Washofsky ◽  
Catherine Gardner ◽  
Robert McCarter ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Hospital Medicine ◽  
Advanced Practice ◽  
Pediatric Hospital ◽  
Medicine Service

An Examination of Physician-, Caregiver-, and Disease-Related Factors Associated With Readmission From a Pediatric Hospital Medicine Service

2015 ◽  
Vol 5 (11) ◽  
pp. 566-573 ◽  
Author(s):  
S. S. Wallace ◽  
S. L. Keller ◽  
C. N. Falco ◽  
J. A. Nead ◽  
C. G. Minard ◽  
...  
Keyword(s):  
Hospital Medicine ◽  
Pediatric Hospital ◽  
Related Factors ◽  
Factors Associated ◽  
Medicine Service

Use of Transition Resources by Primary Care Providers for Youth With Intellectual and Developmental Disabilities

2018 ◽  
Vol 56 (1) ◽  
pp. 56-68
Author(s):  
Paul B. Dressler ◽  
Teresa K. Nguyen ◽  
Eric J. Moody ◽  
Sandra L. Friedman ◽  
Laura Pickler
Keyword(s):  
Primary Care ◽  
Developmental Disabilities ◽  
Transition Planning ◽  
Primary Care Providers ◽  
Intellectual And Developmental Disabilities ◽  
Care Providers ◽  
Improvement Project ◽  
Successful Transition ◽  
Transition Clinic ◽  
Systemic Barriers

Abstract Youth with intellectual and developmental disabilities (IDD) often experience difficulties with successful transition from pediatric to adult healthcare. A consultative Transition Clinic for youth with IDD was piloted as a quality improvement project, and assessed the engagement of primary care providers (PCPs) for transition planning after patients were seen in clinic. Although many PCPs found the clinic and resources useful, individual and systemic barriers often prohibited them from participating in transition planning for this patient population. These findings highlight systemic barriers that need to be addressed to ensure successful transition, as well as the need for a specialized Transition Clinic with involvement of specialists with expertise in IDD, such as Developmental-Behavioral Pediatrics, to assist throughout transition process.

scholarly journals Improving access to epilepsy care for homeless patients in the Dublin Inner City: a collaborative quality improvement project joining hospital and community care

2021 ◽  
Vol 10 (2) ◽  
pp. e001367
Author(s):  
Elisabeth Doran ◽  
Enda Barron ◽  
Laura Healy ◽  
Lorraine O'Connor ◽  
Cara Synnott ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Care Pathway ◽  
Primary Care Providers ◽  
Quality Improvement Project ◽  
High Rate ◽  
Care Providers ◽  
Improvement Project ◽  
Pathway Of Care ◽  
Patients With Epilepsy

Homelessness is associated with significant psychosocial and health disparities. The rate of epilepsy among this cohort is eight times greater than that in the settled population, and the associated morbidity is higher due to lack of integrated care, difficulties with treatment adherence, substance abuse and poor social circumstances. There is a high rate of seizure-related death in homeless patients. Seizures are one of the most common neurological cause for emergency department presentation among this population. The aim of this quality improvement project was to use a multistakeholder co-production approach to design a new pathway of care for homeless patients with epilepsy to improve access to specialist epilepsy care and to strengthen the links between hospital and community teams who manage this population. After several years of observation, stakeholder engagement and numerous tests of change, we have created a new care pathway and developed bespoke tools for primary care providers and for physicians working in the emergency department to enable them to assess and manage patients as they present, as well as provide access to remote epilepsy specialist support.

scholarly journals Using Electronic Data Collection Platforms to Assess Complementary and Integrative Health Patient-Reported Outcomes: Feasibility Project (Preprint)

2019 ◽  
Author(s):  
Jolie N Haun ◽  
Amy C Alman ◽  
Christine Melillo ◽  
Maisha Standifer ◽  
Julie McMahon-Grenz ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Reported Outcomes ◽  
Primary Care Providers ◽  
Quality Improvement Project ◽  
Care Providers ◽  
Secure Messaging ◽  
Web Based ◽  
Improvement Project ◽  
Integrative Health ◽  
Patient Reported

BACKGROUND The Veteran Administration (VA) Office of Patient-Centered Care and Cultural Transformation is invested in improving veteran health through a whole-person approach while taking advantage of the electronic resources suite available through the VA. Currently, there is no standardized process to collect and integrate electronic patient-reported outcomes (ePROs) of complementary and integrative health (CIH) into clinical care using a web-based survey platform. This quality improvement project enrolled veterans attending CIH appointments within a VA facility and used web-based technologies to collect ePROs. OBJECTIVE This study aimed to (1) determine a practical process for collecting ePROs using patient email services and a web-based survey platform and (2) conduct analyses of survey data using repeated measures to estimate the effects of CIH on patient outcomes. METHODS In total, 100 veterans from one VA facility, comprising 11 cohorts, agreed to participate. The VA patient email services (Secure Messaging) were used to manually send links to a 16-item web-based survey stored on a secure web-based survey storage platform (Qualtrics). Each survey included questions about patient outcomes from CIH programs. Each cohort was sent survey links via Secure Messaging (SM) at 6 time points: weeks 1 through 4, week 8, and week 12. Process evaluation interviews were conducted with five primary care providers to assess barriers and facilitators to using the patient-reported outcome survey in usual care. RESULTS This quality improvement project demonstrated the usability of SM and Qualtrics for ePRO collection. However, SM for ePROs was labor intensive for providers. Descriptive statistics on health competence (2-item Perceived Health Competence Scale), physical and mental health (Patient-Reported Outcomes Measurement Information System Global-10), and stress (4-item Perceived Stress Scale) indicated that scores did not significantly change over time. Survey response rates varied (18/100, 18.0%-42/100, 42.0%) across each of the 12 weekly survey periods. In total, 74 of 100 participants provided ≥1 survey, and 90% (66/74) were female. The majority, 62% (33/53) of participants, who reported the use of any CIH modality, reported the use of two or more unique modalities. Primary care providers highlighted specific challenges with SM and offered solutions regarding staff involvement in survey implementation. CONCLUSIONS This quality improvement project informs our understanding of the processes currently available for using SM and web-based data platforms to collect ePROs. The study results indicate that although it is possible to use SM and web-based survey platforms for ePROs, automating scheduled administration will be necessary to reduce provider burden. The lack of significant change in ePROs may be due to standard measures taking a biomedical approach to wellness. Future work should focus on identifying ideal ePRO processes that would include standardized, whole-person measures of wellness.

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