scholarly journals Patient-Reported Lupus Flare Symptoms Are Associated with Worsened Patient Outcomes and Increased Economic Burden

2020 ◽  
Vol 26 (3) ◽  
pp. 275-283 ◽  
Author(s):  
Patricia Katz ◽  
Winnie W. Nelson ◽  
R. Paola Daly ◽  
Lauren Topf ◽  
Erin Connolly-Strong ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Economic Burden ◽  
Lupus Flare ◽  
Patient Reported

InHouse Call: Streamlining Communication to Optimize Efficiency and Patient Care in a Hospital (Preprint)

2021 ◽  
Author(s):  
George Schilling
Keyword(s):  
Pilot Study ◽  
Patient Outcomes ◽  
Economic Burden ◽  
Team Member ◽  
Average Amount ◽  
Traditional Methods ◽  
Poor Patient ◽  
Net Promoter Score ◽  
The Mean ◽  
Net Promoter

BACKGROUND Communication failures disrupt physician workflow, lead to poor patient outcomes, and are associated with significant economic burden. To increase efficiency with contacting a team member in a hospital, we designed an information directory app, InHouse Call. OBJECTIVE To describe the design of InHouse Call, objectively compare the usefulness of the app versus traditional methods (operator or pocket cards, etc.), and determine its subjective usefulness through user surveys and Net Promoter Score (NPS). METHODS Pilot study utilizing Before-After trials. The effectiveness of InHouse Call in connecting the user with a contact in the hospital was measured through timed trials comparing the amount of time spent in attempting to make the connection using traditional methods versus the app. Usability was measured through exit surveys and NPS. RESULTS The average time spent connecting to the correct contact using traditional methods was 59.5 seconds compared to 13.8 seconds when using InHouse Call. The degree of variance when using traditional methods was 1544.2 compared to 19.7 with InHouse Call. A call made using the traditional methods deviated from the mean by 39.3 seconds compared to 4.4 seconds when using InHouse Call. InHouse Call achieved an NPS of 95. CONCLUSIONS InHouse Call significantly reduced the average amount of time spent connecting with the correct contact as well as the variability to complete the task. The app garnered a high NPS and positive subjective feedback.

scholarly journals Composer—Visual Cohort Analysis of Patient Outcomes

2019 ◽  
Vol 10 (02) ◽  
pp. 278-285 ◽  
Author(s):  
Jen Rogers ◽  
Nicholas Spina ◽  
Ashley Neese ◽  
Rachel Hess ◽  
Darrel Brodke ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Visual Analysis ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Analysis Tool ◽  
Electronic Health Record Data ◽  
Patient Cohort ◽  
Orthopedic Surgeons ◽  
Patient Reported

Objective Visual cohort analysis utilizing electronic health record data has become an important tool in clinical assessment of patient outcomes. In this article, we introduce Composer, a visual analysis tool for orthopedic surgeons to compare changes in physical functions of a patient cohort following various spinal procedures. The goal of our project is to help researchers analyze outcomes of procedures and facilitate informed decision-making about treatment options between patient and clinician. Methods In collaboration with orthopedic surgeons and researchers, we defined domain-specific user requirements to inform the design. We developed the tool in an iterative process with our collaborators to develop and refine functionality. With Composer, analysts can dynamically define a patient cohort using demographic information, clinical parameters, and events in patient medical histories and then analyze patient-reported outcome scores for the cohort over time, as well as compare it to other cohorts. Using Composer's current iteration, we provide a usage scenario for use of the tool in a clinical setting. Conclusion We have developed a prototype cohort analysis tool to help clinicians assess patient treatment options by analyzing prior cases with similar characteristics. Although Composer was designed using patient data specific to orthopedic research, we believe the tool is generalizable to other healthcare domains. A long-term goal for Composer is to develop the application into a shared decision-making tool that allows translation of comparison and analysis from a clinician-facing interface into visual representations to communicate treatment options to patients.

scholarly journals MACHINE-LEARNING IDENTIFIES BEST MEASURES TO PREDICT ACL RECONSTRUCTION OUTCOME

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0014
Author(s):  
Anish GR Potty ◽  
Ajish S. R. Potty ◽  
Rithesh Punyamurthula ◽  
Sreeram Penna ◽  
Chris Benavides ◽  
...  
Keyword(s):  
Machine Learning ◽  
Patient Outcomes ◽  
High Accuracy ◽  
Quality Data ◽  
Critical Survey ◽  
Post Surgery ◽  
Survey Questions ◽  
Acl Surgery ◽  
Patient Reported ◽  
Survey Responses

Introduction: Knee injury and Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported outcome measurement to track recovery after ACL surgery. This study focuses on the function of daily living subscale (KOOS ADL), which is calculated based on 17 questions. By employing machine learning to predict KOOS ADL scores, we sought to better understand the relative importance of the survey questions and thereby identify its most critical components as well as questions that do not adequately predict outcomes. Methods: Pre- and post-operative patient reported KOOS ADL survey responses and outcomes scores following ACL surgery were obtained from the Surgical Outcome System data registry(SOS), an international patient-reported outcomes database sponsored and maintained by Arthrex. Patients with missing KOOS ADL survey responses were excluded from the study. Machine learning (ML) algorithms such as Random Forest and Gradient Boosting were used to identify the most critical survey questions that predict KOOS ADL scores with high accuracy. These decision tree-based algorithms predict patient outcomes using several decision rules and thereby determining the relative value of individual questions at predicting patient deficits (e.g., if patients have “Severe” difficulty in ascending stairs, they are more likely to have globally worse scores than those with difficulty with other tasks). Results: 4996 patients were initially identified. Based on compliance with the survey, 2407, 2407, 1817 and 1193 patients records for pre-surgery, 3 month, 6 month and 1 year post-surgery responses respectively underwent further analysis. The dataset consisted of 53.9% males and 46.1% females. Mean age was 29 (range 11 to 70 years). Results from the ML models indicated that by 6 key questions, over 80% of the variance in KOOS ADL scores could be explained instead of standard 17 survey questions (Table 1). Interestingly, the analysis provided similar accuracy at both 6 months and 1 year. Discussion and Conclusion: Most patients have similar functional deficits that can be captured using a simplified version of the KOOS ADL survey. The abbreviated survey would result in a better patient reporting experience while still obtaining quality data. Additional work on predicting post-surgery scores using ML from pre-surgery responses and other patient information would provide valuable insights; however, predicting outcome scores with high accuracy remains challenging. We advocate for novel methods to identify and measure meaningful data to assist with understanding patient outcomes and thereby proving the true value of orthopaedic interventions on functional status. [Table: see text]

scholarly journals Determining Success or Failure After Foot and Ankle Surgery Using Patient Acceptable Symptom State (PASS) and Patient Reported Outcome Information System (PROMIS)

2018 ◽  
Vol 39 (8) ◽  
pp. 894-902 ◽  
Author(s):  
Michael R. Anderson ◽  
Judith F. Baumhauer ◽  
Benedict F. DiGiovanni ◽  
Sam Flemister ◽  
John P. Ketz ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Patient Outcomes ◽  
Roc Analysis ◽  
Patient Reported Outcome ◽  
Foot And Ankle ◽  
Chi Square ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Patient Acceptable Symptom State ◽  
Chi Square Analysis

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery. Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = 88). Patient outcome as determined by phone interviews included PASS and patients’ judgment of whether their surgery was a S/F. Assessment also included PROMIS physical function (PF), pain interference (PI), and depression (D) scales. The association between S/F and PASS outcomes was evaluated by chi-square analysis. A 2-way analysis of variance (ANOVA) evaluated the ability of PROMIS to discriminate PASS and/or S/F outcomes. Receiver operator curve (ROC) analysis was used to evaluate the ability of pre- (n = 63) and postoperative (n = 88) PROMIS scores to predict patient outcomes (S/F and PASS). Finally, the proportion of individuals classified by the identified thresholds were evaluated using chi-square analysis. Results: There was a strong association between PASS and S/F after surgery (chi-square <0.01). Two-way ANOVA demonstrated that PROMIS t scores discriminate whether patients experienced positive or negative outcome for PASS ( P < .001) and S/F ( P < .001). The ROC analysis showed significant accuracy (area under the curve > 0.7) for postoperative but not preoperative PROMIS t scores in determining patient outcome for both PASS and S/F. The proportion of patients classified by applying the ROC analysis thresholds using PROMIS varied from 43.0% to 58.8 % for PASS and S/F. Conclusions: Patients who found their symptoms and activity at a satisfactory level (ie, PASS yes) also considered their surgery a success. However, patients who did not consider their symptoms and activity at a satisfactory level did not consistently consider their surgery a failure. PROMIS t scores for physical function and pain demonstrated the ability to discriminate and accurately predict patient outcome after foot and ankle surgery for 43.0% to 58.8% of participants. These data improve the clinical utility of PROMIS scales by suggesting thresholds for positive and negative patient outcomes independent of other factors. Level of Evidence: II, prospective comparative series.

Patient-reported outcomes (PROs) from the systemic therapies for HER2-positive metastatic breast cancer (MBC) registry study (SystHERs): Eliciting the patient experience.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 286-286 ◽  
Author(s):  
Sara A. Hurvitz ◽  
Mohammad Jahanzeb ◽  
Peter Kaufman ◽  
Ginny Mason ◽  
Musa Mayer ◽  
...  
Keyword(s):  
Patient Experience ◽  
Economic Burden ◽  
Metastatic Breast ◽  
Reference Ranges ◽  
Her2 Positive ◽  
Job Effectiveness ◽  
Patient Reported ◽  
Trial Outcome Index ◽  
Observational Cohort ◽  
Outcome Index

286 Background: Patients with HER2-positive MBC are, on average, living longer. Data are limited on patient-reported quality of life (QoL) and economic burden during these extended survival periods. In accordance with guidelines for comparative effectiveness research in oncology (Basch et al, 2012), SystHERs, initiated in 2012, includes PROs to capture the patient experience. Here we report baseline (at enrollment) PRO results from SystHERs. Methods: SystHERs is a US-based prospective observational cohort study that aims to enroll 1000 patients with HER2-positive MBC within 6 months of metastatic diagnosis. Patients will be followed for 5–8 years.PROs, including QoL, economic burden, and symptoms related to neuropathy, alopecia, and cognition, are collected at baseline and ~90-day intervals during clinic visits, including after disease progression. Results: As of Feb 17, 2014, 319 patients were enrolled, and baseline data from 306 eligible patients are reported. Median time to enrollment since MBC diagnosis was 2.4 months. At least 1 PRO item was completed by 90% of eligible patients. Scale reference ranges (higher scores indicate better status) and median scores at baseline were: overall HRQoL (0–100)=80.0; FACT-B Trial Outcome Index (0–96)=58.0, and the Rotterdam Activities of Daily Living Scale (0–100)=85.7. One hundred patients (40.3%) were employed. These patients reported on average 36% work time missed (absenteeism) and 30% decreased on-the-job effectiveness (presenteeism) due to MBC. Patients reported a median out-of-pocket MBC-related expenditure of $735 in the past 3 months (range $0–11,700). Of this, the median deductible and copay-related cost was $350. Conclusions: To our knowledge, this is the only HER2-positive MBC patient registry that includes comprehensive PROs to supplement clinical data. To date, participation in PROs is high at baseline (90%).QoL and economic burden were consistent with other studies (Cortés et al, 2013; Zafar et al, 2013). Baseline results for ~500 patients are expected by the time of the congress presentation and will include data on symptoms related to neuropathy, alopecia, and cognition. Clinical trial information: NCT01615068.

scholarly journals Patient-reported outcomes in clinical practice

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 501-506 ◽  
Author(s):  
Sarah Dobrozsi ◽  
Julie Panepinto
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
Patient Reported Outcomes ◽  
Clinical Care ◽  
Patient Reported Outcome ◽  
Physician Communication ◽  
Valuable Data ◽  
Patient Reported ◽  
Improve Patient

Abstract Patient-reported outcome (PRO) measurement plays an increasingly important role in health care and understanding health outcomes. PROs are any report of a patient's health status that comes directly from the patient, and can measure patient symptoms, patient function, and quality-of-life. PROs have been used successfully to assess impairment in a clinical setting. Use of PROs to systematically quantify the patient experience provides valuable data to assist with clinical care; however, initiating use of PROs in clinical practice can be daunting. Here we provide suggestions for implementation of PROs and examples of opportunities to use PROs to tailor individual patient therapy to improve patient outcomes, patient–physician communication, and the quality of care for hematology/oncology patients.

scholarly journals Rationing of Nursing Care and Its Relationship with Nurse Staffing and Patient Outcomes: The Mediation Effect Tested by Structural Equation Modeling

2019 ◽  
Vol 16 (10) ◽  
pp. 1672 ◽  
Author(s):  
Xiaowen Zhu ◽  
Jing Zheng ◽  
Ke Liu ◽  
Liming You
Keyword(s):  
Adverse Events ◽  
Patient Outcomes ◽  
Nursing Care ◽  
Structural Equation ◽  
Nurse Staffing ◽  
Mediation Effect ◽  
Equation Modeling ◽  
Patient Reported ◽  
Quality Assessments ◽  
The Relationship

Purpose: The purpose of this study is to test the mediation effect of rationing of nursing care (RONC) and the relationship this has between nurse staffing and patient outcomes. Methods: The analytic sample included 7802 nurse surveys and 5430 patient surveys. Three patient outcome indicators, nurse staffing, RONC, and confounding factors were considered in the model pathways. Results: The hypothesized model was shown to be statistically significant. In the model, nurses who were in the units with lower nurse-to-patient ratios reported higher scores on RONC, which meant that an increased level of withheld nursing care or a failure to carry out nursing duties was apparent. Nurses who reported a higher score on RONC, scored poorly on the quality assessment and were more frequently involved in patient adverse events. Nurse staffing influenced quality assessments and patient adverse events through RONC. In units with poorer nurse-reported quality assessments or more frequently patient adverse events, patient-reported dissatisfaction scores were higher. Conclusions: The results suggest that a lack of nurse staffing leads to RONC, which leads to poorer patient outcomes. These results are seen when considering the evaluations completed by both nurses and patients. The relationship between staffing numbers and patient outcomes explains the mediating role of RONC.

scholarly journals ASSESSING PATIENT OUTCOMES FOLLOWING A FRACTURE

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0010
Author(s):  
Emily A. Sweeney ◽  
Morgan N. Potter ◽  
Alexia G. Gagliardi ◽  
David R. Howell ◽  
Aaron Provance
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Patient Outcomes ◽  
Sports Medicine ◽  
Young Patients ◽  
Median Score ◽  
Orthopedic Surgeon ◽  
Pediatric Sports Medicine ◽  
Fracture Management ◽  
Patient Reported

Background: Both primary care sports medicine physicians and orthopedic surgeons, in conjunction with advanced practice providers, often manage young patients with fractures. To our knowledge, no investigations have evaluated patient outcomes based on the type of provider they see for fracture management. This study examined fracture management, patient outcomes, and patient satisfaction in pediatric and adolescent patients with fibula, tibia, radius and ulna fractures. Specifically, we sought to determine if there were differences between patients seen by a primary care sports medicine physician or orthopedic surgeon/physician assistant (PA) on measures of time to clearance from the injury, patient-reported functional outcomes, and patient satisfaction. Methods: A retrospective chart review was performed for 4-18 year-old patients who were treated by a sports medicine provider (primary care or orthopedic surgeon/PA) for a fracture of the radius, ulna, tibia or fibula over the course of three months. We contacted patients approximately 10 months post-injury. Patients or their parents completed a patient satisfaction survey (Short Assessment of Patient Satisfaction [SPAS]) and an injury location-specific patient reported functional outcome tool: the Foot and Ankle Ability Measure (FAAM) was used for patients with fibular or tibia fractures; the Disabilities of the Arm, Shoulder, and Hand (DASH) Scale was used for patients with radius or ulna fractures. The SPAS is scored from 0-28 with higher scores indicating higher satisfaction. The DASH is scored from 0-110, while the FAAM is scored from 0-140. For the DASH and FAAM, 0 indicates the least disability. Results: 83 of 139 (60%) of patients who were contacted completed the study. 58 (70%) of patients were treated by pediatric primary care sports medicine physicians and 25 (30%) were treated by a pediatric sports medicine orthopedic surgeon or the surgeon’s PA. Both patient groups (Table 1) were of similar age (10.3±3.1 vs. 8.9±3.9 years; p= 0.09), proportion of females (47% vs. 36%; p= 0.47), proportion of upper extremity injuries (67% vs. 80%; p= 0.30), and number of x-rays obtained (3.2±3.5 vs. 3.5±1.8; p= 0.60). The median time from injury to clinically-confirmed healing was similar between the two groups (47 vs 60.5 days; p=0.54), as was the overall patient satisfaction (Table 2) on the SPAS (median score = 26 [range = 19-28] vs 24 [range 9-28]; p = 0.11). In addition, the patient reported outcomes did not differ significantly between the two groups for the DASH (median score=0 [range= 0-11] vs. 0 [range= 0-43], p= 0.47), or the FAAM (median score= 0 [range= 0-47] vs. 0 [range= 0-0], p= 0.36). A greater proportion of patients that were treated by sports medicine primary care physicians reported they would prefer to see a sports medicine primary care physician for future care relative to the pediatric sports medicine surgeon group (Table 3; 74% vs. 20%; p< 0.001). In contrast, those seen by a sports medicine surgeon or PA indicated they would prefer to see a pediatric PA or pediatric nurse practitioner in the future relative to the pediatric sports medicine primary care group (28% vs. 2%; p= 0.001). Conclusion/Significance: Pediatric primary care sports medicine physicians and pediatric sports medicine orthopedic surgeons, with their PAs, have similar outcomes when caring for young patients with fractures of the radius/ulna and tibia/fibula. Patients report equal satisfaction with their care. Patients will likely have favorable outcomes when they are cared for by any of these providers. Tables and Figures: [Table: see text]

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