scholarly journals Trends in Veteran population use of Veterans Affairs chiropractic care

2021 ◽  
Author(s):  
Ryan Burdick ◽  
Kelsey Corcoran ◽  
Xiwen Zhao ◽  
Anthony Lisi
Keyword(s):  
Mixed Model ◽  
Community Care ◽  
Care Delivery ◽  
Chiropractic Care ◽  
Geographic Region ◽  
Veterans Affairs ◽  
Full Time ◽  
Care Providers ◽  
Full Time Equivalent ◽  
Cross Sectional

Abstract Background The US Department of Veterans Affairs (VA) has initiated various approaches to provide chiropractic care to Veterans. Prior work has shown substantial increase in use of VA chiropractic care between fiscal years (FY) 2005-2016. However, the extent of the availability of these services to the Veteran population remains unclear. The purpose of this study was to analyze the rate of Veteran use of VA chiropractic services, both from on-site care at VA facilities and VA purchased care from community care providers. This study analyzed facility characteristics associated with chiropractic use by both care delivery mechanisms (on-site and in the community).Methods Cross-sectional analyses of administrative data were conducted for FY 2014-19. Data were obtained from VA’s Corporate Data Warehouse. The variables extracted included number of unique Veterans receiving VA chiropractic care on-site and in the community, total Veteran population of the VA facilities, size of the VA chiropractic workforce (measured as Full-Time Equivalent, FTE), and facility characteristics (geographic region and the facility complexity). Descriptive statistics, mixed model, and multivariant models were used to analyze data.Results Use of VA chiropractic care increased over the six-year period for both on-site and community care. National average for on-site use of the population was 1.27% in FY14 and 1.48% in FY19. Community care use was 0.29% and 1.76% for the same years. Use at individual facilities varied widely in each FY. Factors such as chiropractor FTE, geographic locations, and the complexity of the VA facility are associated with use of chiropractic services. ConclusionThe VA has expanded the non-pharmacologic treatments available to Veterans by providing chiropractic services, yet chiropractic use remains low compared to other US populations. As Veterans have a high prevalence of pain and musculoskeletal conditions, continued work to assess and achieve the optimal levels of chiropractic use in this population is warranted.

scholarly journals Trends in Veteran Population Use to Veterans Affairs Chiropractic Care

2021 ◽  
Author(s):  
Ryan Burdick ◽  
Kelsey Corcoran ◽  
Xiwen Zhao ◽  
Anthony Lisi
Keyword(s):  
Mixed Model ◽  
Community Care ◽  
Care Delivery ◽  
Chiropractic Care ◽  
Geographic Region ◽  
Veterans Affairs ◽  
Full Time ◽  
Care Providers ◽  
Full Time Equivalent ◽  
Cross Sectional

Abstract BackgroundThe US Department of Veterans Affairs (VA) has initiated various approaches to provide chiropractic care to Veterans. Prior work has shown substantial increase in use of VA chiropractic care between fiscal years (FY) 2005-2016. However, the extent of the availability of these services to the Veteran population remains unclear. The purpose of this study was to analyze the rate of Veteran use of VA chiropractic services, both from on-site care at VA facilities and VA purchased care from community care providers. This study analyzed facility characteristics associated with chiropractic use by both care delivery mechanisms (on-site and in the community).MethodsCross-sectional analyses of administrative data were conducted for FY 2014-19. Data were obtained from VA’s Corporate Data Warehouse. The variables extracted included number of unique Veterans receiving VA chiropractic care on-site and in the community, total Veteran population of the VA facilities, size of the VA chiropractic workforce (measured as Full-Time Equivalent, FTE), and facility characteristics (geographic region and the facility complexity). Descriptive statistics, mixed model, and multivariant models were used to analyze data.ResultsUse of VA chiropractic care increased over the six-year period for both on-site and community care. National average for on-site use of the population was 1.27% in FY14 and 1.48% in FY19. Community care use was 0.29% and 1.76% for the same years. Use at individual facilities varied widely in each FY. Factors such as chiropractor FTE, geographic locations, and the complexity of the VA facility are associated with use of chiropractic services.ConclusionThe VA has expanded the non-pharmacologic treatments available to Veterans by providing chiropractic services, yet chiropractic use remains low compared to other US populations. As Veterans have a high prevalence of pain and musculoskeletal conditions, continued work to assess and achieve the optimal levels of chiropractic use in this population is warranted.

scholarly journals The Relationship Between Language Barrier in Non-Arabic Nurses and Anxiety in Cardiovascular Patients: A Cross-Sectional Descriptive Study

2021 ◽  
Vol 8 ◽  
pp. 237437352198924
Author(s):  
Jassem Almualem ◽  
Amal Darwish ◽  
Ahmed AlFaraj
Keyword(s):  
Health Care Providers ◽  
Care Delivery ◽  
Descriptive Study ◽  
Language Barrier ◽  
P Value ◽  
Care Providers ◽  
Cross Sectional ◽  
Related Information ◽  
Arabic Speakers ◽  
Arabic Speaking

Patients with cardiac conditions may suffer from anxiety related to prognosis and further rehabilitation. Anxiety could be exacerbated by different factors including miscommunication, which could be attributed to the linguistic barrier, that exists among health care providers. At Saud Al-Babtain Cardiac Center (SBCC), nurses who are non-native Arabic speakers could have difficulty communicating disease-related information at different stages of nursing care. Is it possible to identify the language barrier as a source of anxiety for admitted patients with cardiac diseases? In this cross-sectional, descriptive study, 50 patients were included following the diagnosis of cardiac disease and post-cardiac surgery. A questionnaire that measures anxiety level showed that patients who were handled by Arabic-speaking nurses reported less collective mean for the anxiety domain statements of (20.08) versus those who were handled by Non-Arabic-speaking nurses (28.55, P value = .041). Our finding indicates that anxiety levels increased when there was a language barrier between nurses and patients, which could affect the quality of care delivery at SBCC.

scholarly journals Potential Benefits and Drawbacks of Virtual Clinics in General Surgery: Pilot Cross-Sectional Questionnaire Study (Preprint)

2018 ◽  
Author(s):  
Emily Rutherford ◽  
Roghinio Noray ◽  
Caolán Ó HEarráin ◽  
Kevin Quinlan ◽  
Aisling Hegarty ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Providers ◽  
Care Delivery ◽  
Day Surgery ◽  
Care Providers ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Specialist Health Care ◽  
Outpatient Settings

BACKGROUND Escalating demand for specialist health care puts considerable demand on hospital services. Technology offers a means by which health care providers may increase the efficiency of health care delivery. OBJECTIVE The aim of this study was to conduct a pilot study of the feasibility, benefits, and drawbacks of a virtual clinic (VC) in the general surgical service of a busy tertiary center. METHODS Patient satisfaction with current care and attitudes to VC were surveyed prospectively in the general surgical outpatient department (OPD; n=223). A subset of patients who had undergone endoscopy and day surgery were recruited to follow-up in a VC and subsequently surveyed with regard to their satisfaction (20/243). Other outcomes measured included a comparison of consultation times in traditional and virtual outpatient settings and financial cost to both patients and the institution. RESULTS Almost half of the patients reported barriers to prospective use of VCs. However, within the cohort who had been followed-up in the VC, satisfaction was higher than the traditional OPD (100% as compared with 187/223, 83.9%). Significant savings in both time (<italic>P</italic>=.003) and financial costs to patients and the institution were found. CONCLUSIONS For an appropriately selected group of patients, VCs offer a viable alternative to traditional OPD. This alternative can improve both patient satisfaction and efficiency of patient care.

scholarly journals The association between midwifery staffing levels and the experiences of mothers on postnatal wards: cross sectional analysis of routine data

2021 ◽  
Author(s):  
Lesley Y Turner ◽  
David Culliford ◽  
Jane E Ball ◽  
Ellen Kitson-Reynolds ◽  
Peter D Griffiths
Keyword(s):  
Postnatal Care ◽  
Routine Data ◽  
Full Time ◽  
Full Time Equivalent ◽  
Cross Sectional ◽  
Negative Experiences ◽  
Staffing Levels ◽  
Post Natal Care ◽  
The Difference ◽  
Sectional Analysis

Background Women have consistently reported lower satisfaction with postnatal care compared with antenatal and labour care. The aim of this research was to examine whether women's experience of inpatient postnatal care in England is associated with variation in midwifery staffing levels. Methods Analysis of data from the National Maternity Survey in 2018 including 17,611 women from 129 organisations. This was linked to hospital midwifery staffing numbers from the National Health Service (NHS) Workforce Statistics and the number of births from Hospital Episode Statistics. A two-level logistic regression model was created to examine the association of midwifery staffing levels and experiences in post-natal care. Results The median full time equivalent midwives per 100 births was 3.55 (interquartile range 3.26 to 3.78). Higher staffing levels were associated with less likelihood of women reporting delay in discharge (adjusted odds ratio [aOR] 0.849, 95% CI 0.753 to 0.959, p=0.008), increased chances of women reporting that staff always helped in a reasonable time aOR1.200 (95% CI 1.052, 1.369, p=0.007) and that they always had the information or explanations they needed aOR 1.150 (95% CI 1.040, 1.271, p=0.006). Women were more likely to report being treated with kindness and understanding with higher staffing, but the difference was small and not statistically significant aOR 1.059 (0.949, 1.181, p=0.306). Conclusions Negative experiences for women on postnatal wards were more likely to occur in trusts with fewer midwives. Low staffing could be contributing to discharge delays and lack of support and information, which may in turn have implications for longer term outcomes for maternal and infant wellbeing.

scholarly journals Factors Associated With Use of Telemedicine for Follow-Up of SLE in the COVID-19 Outbreak

2021 ◽  
Vol 8 ◽  
Author(s):  
Ho So ◽  
Evelyn Chow ◽  
Isaac T. Cheng ◽  
Sze-Lok Lau ◽  
Tena K. Li ◽  
...  
Keyword(s):  
Care Delivery ◽  
Significant Proportion ◽  
Damage Index ◽  
Physician Global Assessment ◽  
Full Time ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Mean

Objective: To investigate the factors associated with telemedicine (TM) use for follow-up of Systemic Lupus Erythematous (SLE) patients in the COVID-19 pandemic.Methods: This was a single-centered cross-sectional study conducted in Hong Kong. Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM in the form of videoconferencing. The demographic, socioeconomic, and disease data of the first 140 patients opted for TM and 140 control patients preferred to continue standard in-person follow-up were compared.Results: The mean age of all the participants was 45.6 ± 11.8 years, and the disease duration was 15.0 ± 9.2 years. The majority of them were on prednisolone (90.0%) and immunosuppressants (67.1%). The mean SLEDAI-2k was 3.4 ± 2.4, physician global assessment (PGA) was 0.46 ± 0.62 and Systemic Lupus International Collaborating Clinics (SLICC) damage index was 0.97 ± 1.23. A significant proportion of the patients (72.1%) had 1 or more comorbidities. It was found that patients with higher mean PGA (TM: 0.54 ± 0.63 vs. control: 0.38 ± 0.59, p = 0.025) and family monthly income &gt; USD 3,800 (TM: 36.4% vs. control: 23.6%; p = 0.028) preferred TM, while full-time employees (TM: 40.0% vs. control: 50.7%; p = 0.041) preferred in-person follow-up. These predictors remained significant in the multivariate analysis after adjusting for age and gender. No other clinical factors were found to be associated with the preference of TM follow-up.Conclusion: When choosing the mode of care delivery between TM and physical clinic visit for patients with SLE, the physician-assessed disease activity and patient's socio-economic status appeared to be important.

scholarly journals Associations Between Nonclinical Services and Patient-Experience Outcomes in US Acute Care Hospitals

2019 ◽  
Vol 7 (6) ◽  
pp. 1086-1093
Author(s):  
Melody K Schiaffino ◽  
Yukari Suzuki ◽  
Tarryn Ho ◽  
Tracy L Finlayson ◽  
Jeffrey S Harman
Keyword(s):  
Patient Education ◽  
Patient Experience ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Organizational Factors ◽  
Relevant Information ◽  
Full Time ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Experience Of Care

Background: Patient experience is an important measure of hospital quality and performance. Since the passage of the Affordable Care Act, patient experiences with their care encounters are embedded into the framework of payment incentives. However, drivers of patient experience in the context of the supportive, nonclinical, services that relate to patient care have not been as well understood. Aims: To assess the role of organizational factors on patient experience. Methods: This cross-sectional analysis integrates hospital patient-experience scores from Hospital Consumer Assessment of Healthcare Providers and Systems, and Centers for Medicaid and Medicare Service data from 2013 to 2015 (N = 3392). Based on hospitals with “top-box” responses, the aggregate proportion of hospital patients responding “always” on a Likert scale represented a top-box hospital. Domains were split at the mean for analysis (above average = 1). Multivariable logistic regression models for each domain were analyzed against hospital factors and services, including offering a patient education center, patient-enabling services, and language services. Results: Most hospitals reported a full-time hospitalist (64.4%) and a patient education center (60.4%), while fewer provided enabling/support services (33.7%). In multivariable models, small and medium hospitals performed better compared to the largest hospitals (300+ beds; P < .0001). Structurally, medium and small hospitals reported significantly greater odds of top-box patient-experience versus large hospitals. Across all domains, only hospitals with patient education centers returned better performance (adjusted odds ratio: 1.27-1.64; P = .0002-.0166). Discussion/Conclusion: Patient education centers provide relevant information at the point of service and may improve overall patient experience of care. Given the growing reliance on accountable care delivery models, opportunities to partner with community health education partners may be profitable.

scholarly journals A Study of Advanced Practice Provider Staffing Models and Professional Development Opportunities at National Comprehensive Cancer Network Member Institutions

2021 ◽  
Vol 12 (7) ◽  
Author(s):  
Annie Austin, MSN, AGACNP, AOCNP ◽  
Kellyann Jeffries, CNP ◽  
Diana Krause, MHA ◽  
Jessica Sugalski, MPPA ◽  
Karen Sharrah, DNP, APRN, FNPc ◽  
...  
Keyword(s):  
Professional Development ◽  
Leadership Development ◽  
National Comprehensive Cancer Network ◽  
Mixed Model ◽  
Network Member ◽  
Advanced Practice ◽  
Full Time ◽  
Full Time Equivalent ◽  
Cancer Network

Introduction: The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an Advanced Practice Provider (APP) Workgroup to develop recommendations to support APP roles at NCCN Member Institutions. Methods: The Workgroup conducted three surveys to understand APP program structure, staffing models, and professional development opportunities at NCCN Member Institutions. Results: The total number of new and follow-up visits a 1.0 APP full-time equivalent conducts per week in shared and independent visits ranged from 11 to 97, with an average of 40 visits per week (n = 39). The type of visits APPs conduct include follow-up shared (47.2%), follow-up independent (46%), new shared (6.5%), and new independent visits (0.5%). Seventy-two percent of respondents utilize a mixed model visit type, with 15% utilizing only independent visits and 13% utilizing only shared visits (n = 39). Of the 95% of centers with APP leads, 100% indicated that leads carry administrative and clinical responsibilities (n = 20); however, results varied with respect to how this time is allocated. Professional development opportunities offered included posters, papers, and presentations (84%), leadership development (57%), research opportunities (52%), writing book chapters (19%), and other professional development activities (12%; n = 422). Twenty percent of APPs indicated that protected time to engage in development opportunities should be offered. Conclusion: As evidenced by the variability of the survey results, the field would benefit from developing standards for APPs. There is a lack of information regarding leadership structures to help support APPs, and additional research is needed. Additionally, centers should continuously assess the career-long opportunities needed to maximize the value of oncology APPs.

scholarly journals Impact of COronaVirus Disease -2019 (COVID-19) pandemic on Haemodialysis care delivery pattern in Karnataka, India- a cross-sectional, questionnaire based survey.

2020 ◽  
Author(s):  
Anupama Y J ◽  
Arvind Conjeevaram ◽  
Ravindra Prabhu A ◽  
Manjunath Doshetty ◽  
Sanjay Srinivasa ◽  
...  
Keyword(s):  
Care Delivery ◽  
National Policy ◽  
Well Being ◽  
Care Providers ◽  
Movement Restriction ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Dialysis Facilities ◽  
The Impact

The COVID-19 pandemic has disrupted health care delivery globally. Patients on in-centre haemodialysis(HD) are particularly affected due to their multiple hospital visits and the need for uninterrupted care for their well-being and survival. We studied the impact of the pandemic and the national policy for pandemic control on the HD care delivery in Karnataka state in India in April 2020, when the first and second national lockdown were in place. An online, questionnaire based survey of dialysis facilities was conducted and the responses analysed. The questions were pertaining to the key areas such as changes in number of dialysis treatments, frequency, duration, expenses, transportation to and from dialysis units, impact on availability of consumables, effect on dialysis personnel and on machine maintenance. 62 centres participated. Median of dialysis treatments for the months of March and April 2020 were 695.5 and 650 respectively. Reduction in dialysis treatments was noted in 29(46.8%) facilities , decreased frequency reported by 60 centres. In at least 35(56.5%) centres, dialysis patients had to bear increased expenses. Cost and availability of dialysis consumables were affected in 40(64.5%) and 55(88.7%) centres respectively. Problems with transportation and movement restriction were the two key factors affecting both patients and dialysis facilities.This survey documents the collateral impact of COVID -19 on the vulnerable group of patients on HD, even when not affected by COVID. It identifies the key areas of challenges faced by the patients and the facilities and implores the care-providers for finding newer avenues for mitigation of the problems. Key words: COVID-19, India, Haemodialysis , dialysis care delivery, questionnaire-based survey

scholarly journals Measuring Electronic Health Record Use in the Pediatric ICU Using Audit-Logs and Screen Recordings

2021 ◽  
Vol 12 (04) ◽  
pp. 737-744
Author(s):  
Amrita Sinha ◽  
Lindsay A. Stevens ◽  
Felice Su ◽  
Natalie M. Pageler ◽  
Daniel S. Tawfik
Keyword(s):  
Electronic Health Record ◽  
Pediatric Intensive Care ◽  
Clinical Activity ◽  
Inpatient Setting ◽  
Health Record ◽  
Full Time ◽  
Care Providers ◽  
Provider Type ◽  
Full Time Equivalent ◽  
Electronic Health

Abstract Background Time spent in the electronic health record (EHR) has been identified as an important unit of measure for health care provider clinical activity. The lack of validation of audit-log based inpatient EHR time may have resulted in underuse of this data in studies focusing on inpatient patient outcomes, provider efficiency, provider satisfaction, etc. This has also led to a dearth of clinically relevant EHR usage metrics consistent with inpatient provider clinical activity. Objective The aim of our study was to validate audit-log based EHR times using observed EHR-times extracted from screen recordings of EHR usage in the inpatient setting. Methods This study was conducted in a 36-bed pediatric intensive care unit (PICU) at Lucile Packard Children's Hospital Stanford between June 11 and July 14, 2020. Attending physicians, fellow physicians, hospitalists, and advanced practice providers with ≥0.5 full-time equivalent (FTE) for the prior four consecutive weeks and at least one EHR session recording were included in the study. Citrix session recording player was used to retrospectively review EHR session recordings that were captured as the provider interacted with the EHR. Results EHR use patterns varied by provider type. Audit-log based total EHR time correlated strongly with both observed total EHR time (r = 0.98, p < 0.001) and observed active EHR time (r = 0.95, p < 0.001). Each minute of audit-log based total EHR time corresponded to 0.95 (0.87–1.02) minutes of observed total EHR time and 0.75 (0.67–0.83) minutes of observed active EHR time. Results were similar when stratified by provider role. Conclusion Our study found inpatient audit-log based EHR time to correlate strongly with observed EHR time among pediatric critical care providers. These findings support the use of audit-log based EHR-time as a surrogate measure for inpatient provider EHR use, providing an opportunity for researchers and other stakeholders to leverage EHR audit-log data in measuring clinical activity and tracking outcomes of workflow improvement efforts longitudinally and across provider groups.

scholarly journals Satisfaction of patients attending a rural hospital of Darjeeling district in West Bengal, India

2017 ◽  
Vol 4 (6) ◽  
pp. 1932 ◽  
Author(s):  
Priti Agarwal ◽  
Romy Biswas
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Health Care Services ◽  
Care Delivery ◽  
Rural Hospital ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional

Background: Patient satisfaction is a means of measuring the effectiveness of health care delivery. This serves as a means of improvement among health care providers to give an acceptable level of patient satisfaction. Aims and Objectives: To assess the level of satisfaction and reasons of dissatisfaction among patients regarding health care services in a rural hospital of Darjeeling District, West Bengal.Methods: A cross-sectional survey was done on 110 patients with the help of PSQ-18 questionnaire. The samples were drawn by systematic random sampling            .Results: The overall mean satisfaction score was 3.57 and S.D. ±0.69. The mean score was highest in general satisfaction domain which was found to be 3.76 with S.D ± 1.08 and lowest in time spent with doctor where mean score was 2.92 and S.D. ±1.07. 69.3% of the patients were satisfied with the services offered by the hospital. The time spent by the doctor with the patient was less and this was the major reason of dissatisfaction.Conclusions: More than half of the patients were satisfied with the services provided by the hospital. The findings of the study can facilitate the development of targeted, objectively prioritized programs for the improvement and advancement of health care delivery systems. 

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