scholarly journals The Impact of COVID-19 on Missed Ophthalmology Clinic Visits

2021 ◽  
Vol Volume 15 ◽  
pp. 4645-4657
Author(s):  
Arthur R Brant ◽  
Suzann Pershing ◽  
Olivia Hess ◽  
David Rooney ◽  
Jeffrey Goldberg ◽  
...  
Keyword(s):  
The Impact ◽  
Clinic Visits

The effect of a mobile health app on adherence to physical health treatment. (Preprint)

2021 ◽  
Author(s):  
Jay Greenstein ◽  
Robert Topp ◽  
Jena Etnoyer-Slaski ◽  
Michael Staelgraeve ◽  
John McNulty ◽  
...  
Keyword(s):  
Physical Health ◽  
Mobile Phone ◽  
Usual Care ◽  
Usual Care Group ◽  
Clinic Visit ◽  
Care Group ◽  
Health Treatment ◽  
Rehabilitation Clinic ◽  
The Impact ◽  
Clinic Visits

BACKGROUND Adhering to prescribed medical interventions predicts the efficacy of the treatment. In the physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps have been introduced with patients to increase their adherence with attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending a chiropractic and rehabilitation clinic visits. OBJECTIVE The purpose of this study was to compare adherence with prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. METHODS The medical records of new patients who presented for care during 2019 and 2020 at five community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and if the patient was provider discharged or self-discharged. During this 24-month study 36.3% of the 4,126 patients seen in the targeted clinics had downloaded the Kanvas App to their mobile phone while the remaining patients chose not to download the app (Usual Care Group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits which could be redeemed for an incentive. RESULTS During both 2019 and 2020 respectively the Kanvas App Group (50%-38%) were provider discharged at a greater rate than the Usual-Care group (47-31%). The Kanvas App Group kept a similar number of appointments compared to the Usual-Care Group in 2019 (10.20 vs. 8.68) but kept significantly more appointments than the Usual-Care Group in 2020 (11.63 vs. 7.67). During 2019 both groups exhibited a similar number of no-show appointments (1.89 vs 1.96) but in 2020 the Kanvas App Group demonstrated more no-show appointments (2.89 vs 2.14) than the Usual Care. When collapsed across years and self discharged the Kanvas App group had a greater number of kept appointments (7.79) compared to the Usual Care group (4.58). When provider discharged both groups exhibited a similar number of kept appointments (15.25 vs 13.82). The Kanvas App group (1.38) and the Usual Care group (1.34) were similar in the number of no-show appointments when provider discharged and when self-discharged the Kanvas App Group had more no-show appointments (3.37) compared to the Usual Care Group (2.44). CONCLUSIONS When patients were provider discharged, they exhibited a similar number of kept appointments and no-show appointment. When subjects were self-discharged and received the Kanvas App they exhibited 3.2 more kept appointments and .94 more no-show appointments than self-discharged Usual Care group.

scholarly journals High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China

2020 ◽  
Author(s):  
Jing Zhang ◽  
Wei-ming Tang ◽  
Xia Jin ◽  
Hong-yi Wang ◽  
Zhen-xing Chu ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Clinic Visit ◽  
Cross Sectional ◽  
On Demand ◽  
Testing Frequency ◽  
Self Testing ◽  
Exposure Prophylaxis ◽  
Sectional Analysis ◽  
The Impact ◽  
Clinic Visits

Abstract Background: Many Pre-exposure prophylaxis (PrEP) users have difficulty attending the quarterly facility-based HIV testing, which leads to the potential risk of drug resistance in the context of breakthrough infection with low drug compliance. We explored the acceptance of HIV self-testing (HIVST) service among PrEP recipients. Methods: MSM were recruited for the PrEP demonstration in four major cities in China from December 2018 to September 2019, provided with regimens of both daily and on-demand PrEP. Facility-based HIV testing was provided quarterly at clinic visits. Previous HIV testing history and acceptance of free HIVST kits to use between each quarterly clinic visit was collected. Correlates of levels of acceptance were analysed using multivariable ordinal logistic regression. Results: We recruited 1,222 MSM. among which 48.5% preferred daily PrEP and 51.5% preferred on-demand PrEP. There was 26.8% (321/1222) had never been to any facility-based HIV testing previously, and the self-reported major reason was that they had already routinely used HIVST. A quarter of the participants (74.5%, 910/1222) had used HIVST previously. There were 1184 MSM (96.9%) accepted to use HIVST between each quarterly clinic visits during PrEP usage, composing 947 ( 77.5%) very willing to, 237（19.4%）willing to, 29 (2.4%) unwilling to, and 9 (0.7%) very unwilling to. Participants preferred daily PrEP (vs. on-demand PrEP, aOR=1.8, 95% CI:1.3-2.4) and had less than 2 times of facility-based HIV testing in the past year (vs. ³2, aOR=1.4,95% CI:1.1-1.9) were more likely to have higher level of acceptance of HIVST.Conclusions: MSM had high acceptance of HIVST, especially among those preferred daily PrEP and with less facility-based HIV testing in the previous year. Offering HIVST services PrEP recipients is feasible and necessary. Above result is of great significance for promoting HIVST among PrEP users during COVID-19, improving awareness of their HIV infection status and ensuring compliance with medication. Future study should exam the impact of HIVST on HIV testing frequency among PrEP users.Trial registration: ChiCTR1800020374 on 27th Dec 2018. http://www.chictr.org.cn/searchproj.aspx

scholarly journals Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study (Preprint)

2020 ◽  
Author(s):  
Hector Roux de Bézieux ◽  
James Bullard ◽  
Orville Kolterman ◽  
Michael Souza ◽  
Fanny Perraudeau
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Control ◽  
Glucose Monitoring ◽  
Smartphone App ◽  
Proof Of Concept ◽  
Medical Food ◽  
Concept Study ◽  
Glucose Levels ◽  
The Impact ◽  
Clinic Visits

BACKGROUND Novel wearable biosensors, ubiquitous smartphone ownership, and telemedicine are converging to enable new paradigms of clinical research. A new generation of continuous glucose monitoring (CGM) devices provides access to clinical-grade measurement of interstitial glucose levels. Adoption of these sensors has become widespread for the management of type 1 diabetes and is accelerating in type 2 diabetes. In parallel, individuals are adopting health-related smartphone-based apps to monitor and manage care. OBJECTIVE We conducted a proof-of-concept study to investigate the potential of collecting robust, annotated, real-time clinical study measures of glucose levels without clinic visits. METHODS Self-administered meal-tolerance tests were conducted to assess the impact of a proprietary synbiotic medical food on glucose control in a 6-week, double-blind, placebo-controlled, 2×2 cross-over pilot study (n=6). The primary endpoint was incremental glucose measured using Abbott Freestyle Libre CGM devices associated with a smartphone app that provided a visual diet log. RESULTS All subjects completed the study and mastered CGM device usage. Over 40 days, 3000 data points on average per subject were collected across three sensors. No adverse events were recorded, and subjects reported general satisfaction with sensor management, the study product, and the smartphone app, with an average self-reported satisfaction score of 8.25/10. Despite a lack of sufficient power to achieve statistical significance, we demonstrated that we can detect meaningful changes in the postprandial glucose response in real-world settings, pointing to the merits of larger studies in the future. CONCLUSIONS We have shown that CGM devices can provide a comprehensive picture of glucose control without clinic visits. CGM device usage in conjunction with our custom smartphone app can lower the participation burden for subjects while reducing study costs, and allows for robust integration of multiple valuable data types with glucose levels remotely. CLINICALTRIAL ClinicalTrials.gov NCT04424888; http://clinicaltrials.gov/ct2/show/NCT04424888.

Impact of pharmacokinetic (CYP2C9) and pharmacodynamic (VKORC1, F7, GGCX, CALU, EPHX1) gene variants on the initiation and maintenance phases of phenprocoumon therapy

2011 ◽  
Vol 105 (01) ◽  
pp. 169-180 ◽  
Author(s):  
Beate Luxembourg ◽  
Katharina Schneider ◽  
Katja Sittinger ◽  
Stefan Toennes ◽  
Erhard Seifried ◽  
...  
Keyword(s):  
Maintenance Phase ◽  
Individual Variability ◽  
Anticoagulation Clinic ◽  
Gene Variants ◽  
Outcome Parameters ◽  
Initiation Phase ◽  
Time Out ◽  
Retrospective Study Design ◽  
The Impact ◽  
Clinic Visits

SummaryCompared to warfarin, little is known about the effect of pharmacogenomics on the inter-individual variability of phenprocoumon therapy. In a retrospective cohort study, we investigated the impact of VKORC1 c.-1639G>A; CYP2C9*2, CYP2C9*3; GGCX c.214+597G>A; CALU c.*4A>G; EPHX1 c.337T>C; F7 c.-402G>A, and F7 c.-401G>T on the initiation (n=54) and maintenance phases (n=91) of phenprocoumon therapy. We assessed the following outcome parameters: time to stable international normalised ratio (INR), time to first supra-therapeutic INR, time out of INR range, probability of over-anticoagulation, number of anticoagulation clinic visits. During the initiation phase, homozygotes for the VKORC1 c.-1639 A and G alleles achieved stable INRs later (p<0.001), spent more time at supra-therapeutic INRs (p<0.001), had increased risks of over-anticoagulation (odds ratio 19.83, p=0.003 and 4.45, p=0.045, respectively), and had higher frequencies of anticoagulation clinic visits (p<0.001) compared to GA carriers. CYP2C9*2, *3 carriers reached stable INRs faster (p=0.024) with fewer anticoagulation clinic visits (p=0.001) than wild-type carriers. EPHX1 c.337 C carrier spent significantly more time above range in the initiation phase (p=0.023). GGCX, CALU, and F7 gene variants did not affect outcome parameters of the initiation phase and none of the genotypes had an impact on maintenance phase parameters. Compared to the VKORC1 genotype, early INR values were less informative in the prediction of outcome parameters such as time to stable INR and time above the INR range. Our study is limited by the retrospective study design with no standardised protocol in a usual care setting. Therefore, our findings should be validated in a larger, controlled prospective study.

scholarly journals Trends of follow-up clinic visits and admissions three-months before and during COVID-19 pandemic at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: an interrupted time series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Workeabeba Abebe ◽  
Alemayehu Worku ◽  
Tamirat Moges ◽  
Nuhamin Tekle ◽  
Wondowossen Amogne ◽  
...  
Keyword(s):  
Health Care ◽  
Time Series ◽  
Random Fluctuation ◽  
First Report ◽  
Specialized Hospital ◽  
Tikur Anbessa Specialized Hospital ◽  
Significant Difference ◽  
The Impact ◽  
Clinic Visits

Abstract Background Following the first report of the COVID-19 case in Ethiopia on March 13, 2020, the country promptly adopted a lockdown policy to contain the virus’s spread. Responding to the healthcare burden imposed by the COVID-19 pandemic had to be coupled with ensuring essential health care services. This study assessed the impact of COVID-19 on the trends in hospital visits and admissions at Tikur Anbessa Specialized Hospital by comparing the rate of follow-up clinic visits and admissions for the 3 months before and after the first report of the COVID-19 case. Methods A retrospective, time-series study examined the trend in follow-up visits and admissions between December 11, 2019, to June 7, 2020, with the 1st case of the COVID-19 report in Ethiopia (March 13, 2020) as a reference time. To control seasonal effects and random fluctuation, we have compared health care utilization to its equivalent period in 2018/19. A data extraction tool was used to collect secondary data from each unit’s electronic medical recordings and logbooks. Results A total of 7717 visits from eight follow-up clinics and 3310 admissions were collected 3 months before the onset of COVID-19. During the following 3 months after the onset of the pandemic, 4597 visits and 2383 admissions were collected. Overall, a 40.4% decrease in follow-up visits and a 28% decline in admissions were observed during the COVID-19 pandemic. A drop in the daily follow-up visits was observed for both genders. The number of visits in all follow-up clinics in 2019/2020 decreased compared to the same months in 2018/19 (p < 0.05). Follow-up visits were substantially lower for renal patients (− 68%), patients with neurologic problems (− 53.9%), antiretroviral treatment clinics (− 52.3%), cardiac patients (− 51.4%). Although pediatric emergency admission was significantly lower (− 54.1%) from the baseline (p = 0.04), admissions from the general pediatric and adult wards did not show a significant difference. Conclusions A decline in follow-up clinic visits and emergency admissions was observed during the first months of the COVID-19 pandemic. This will increase the possibility of avoidable morbidity and mortality due to non-COVID-19-related illnesses. Further studies are needed to explore the reasons for the decline and track the pandemic’s long-term effects among non-COVID-19 patients.

scholarly journals Healthcare Utilization Among Children and Adolescents with Sickle Cell Disease during the COVID-19 Pandemic

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 30-31
Author(s):  
Andrea Nowlin ◽  
Kristina Lai ◽  
Alexander Maillis ◽  
Patricia Waters ◽  
Beatrice Gee ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Sickle Cell ◽  
Outpatient Clinic ◽  
Respiratory Infections ◽  
Cell Disease ◽  
Advisory Committees ◽  
Face To Face ◽  
Outpatient Visits ◽  
The Impact ◽  
Clinic Visits

Background Early experience with the COVID-19 pandemic showed disproportionately high morbidity and mortality among individuals with certain chronic medical conditions. Individuals with sickle cell disease (SCD) are at high risk for pulmonary and other complications including acute chest syndrome (ACS) and have high rates of hospitalization from other viral respiratory infections, raising concern that COVID-19 would be associated with higher morbidity, mortality and health care utilization among those with SCD. Public health interventions such as social distancing, avoidance of large group activities, and widespread use of masks have been shown to reduce the transmission of COVID-19 in the general population but have been inconsistently implemented. In Georgia, COVID-19 restrictions, including school closures, were implemented in mid-March, and on-site school instruction was replaced by virtual instruction for the remainder of the school year. At our institution, most routine, non-urgent outpatient clinic visits were cancelled or postponed from mid-March through May in order to minimize COVID-19 exposure risk. Efforts to initiate the use of telemedicine as an alternative to in-person office visits were rapidly instituted. We hypothesized that adherence to public health restrictions, especially sheltering in place, would be high among patients and families with SCD, and sought to measure the impact of COVID pandemic on healthcare utilization in children and adolescents with SCD in the Atlanta area. Methods The SCD Program at Children's Healthcare of Atlanta (CHOA) provides comprehensive outpatient, emergency and inpatient services at 3 locations in metropolitan Atlanta. CHOA's Sickle Cell Clinical Database (SCCD) contains prospectively collected demographic, diagnostic, treatment and other clinical information on all patients with SCD beginning in 2010, including all outpatient clinic, emergency department (ED) and inpatient hospital utilization. To assess the impact of COVID-19 on healthcare utilization, we tracked clinic, ED and inpatient utilization for the 4-month period (March through June) 2020 compared with the same 4-month period in 2018 and 2019. Results The figure shows utilization patterns for each four-month period from 2018-2020. As expected, face to face outpatient clinic visits fell dramatically from February to April 2020 (-25% in March, -64% in April) and then returned to pre-COVID levels by June. The addition of telemedicine visits raised total outpatient visits in June 2020 to above pre-COVID levels. Total utilization during the 4-month period in 2020 were compared to the mean for the same periods in 2018 and 2019. Face to face clinic visits decreased from 2971.5 to 2023 (-32%), ED visits from 1,217 to 687 (-44%), and total inpatient admissions from 699 to 410 (-41%). Admissions with a primary discharge diagnosis of pain decreased from a mean of 407 in 2018-2019 to 173 (-57%), fever/infection from 67.5 to 40 (-41%), and ACS from 101 to 75 (-26%). Patients with chronic pain and/or history of high utilization (&gt;5 admissions in a given year) showed decreases in utilization similar to all other patients. Summary These data describe the significant changes in utilization among pediatric patients with SCD during the COVID-19 pandemic. Face to face outpatient clinic visits decreased during March and April but returned to pre-COVID levels in June. Unexpectedly, ED and inpatient hospital utilization for acute illness decreased dramatically through April and remained low through June. In March there was a significant decrease in the clinic setting due to a large number of cancelled or rescheduled outpatient visits, despite many being rescheduled as telemedicine visits. However, the largest unexpected decrease was seen in emergency department visits and hospitalizations for acute events, specifically fever and pain events. It is also important to note the decreased utilization of patients with chronic pain who are typically high utilizers. During clinic encounters, families mentioned that less stress from school, reduced respiratory infections, and better medication adherence with parents at home, were possible contributors to reduced sickle cell symptoms while sheltering in place. These observations will guide the development of a patient survey with the goal of obtaining qualitative data to explain the reasons for decreased utilization during the pandemic. Figure Disclosures Lane: FORMA Therapeutics: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Patient-Reported Outcome Measures Identify Impairment Better Than Clinician Documentation during Pediatric Cancer Treatment

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3291-3291 ◽  
Author(s):  
Sarah K. Dobrozsi ◽  
Julie A. Panepinto
Keyword(s):  
Depressive Symptoms ◽  
Standard Deviation ◽  
Cancer Treatment ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Impaired Function ◽  
Patient Reported ◽  
The Mean ◽  
The Impact ◽  
Clinic Visits

Introduction: Children receiving treatment for cancer commonly experience symptoms during their course that impact patient function. Understanding limitations to patient function caused by symptoms is critical to supporting children through their illness; however assessment of function is not standardized which can result in the under recognition of symptoms. Patient-reported outcome measures (PROs) can systematically measure and quantify the impact of symptoms on patient function. PROs have the potential to improve clinician recognition of symptoms and provide additional objective information about the impact of symptoms on patient function. However, to date there are minimal data using PROs in a clinical setting to detect symptoms and function in children receiving treatment for cancer. The objective of this study was to determine if symptoms causing significant impact on patient function as detected by PROs are recognized by standard clinician interview. We hypothesize that PROs identify symptoms causing significant burden to patients with greater sensitivity than clinician documentation. Methods: We conducted a prospective study of children age 8-21 years old that began treatment for cancer within the previous 4 weeks. Patients completed self-reported PROMIS questionnaires measuring impaired mobility, pain, fatigue, anxiety, and depressive symptoms monthly at outpatient clinic visits during the first 6 months of cancer treatment. PROMIS is a validated PRO that provides separate scores for each symptom measured with a mean score of 50 and standard deviation of 10. Patients with scores more than 1 standard deviation from the mean (T score ≥ 10 points from mean of 50) have significantly impaired function. Clinician documentation of symptoms at clinic visits were abstracted from the medical record in dichotomous fashion (present/absent) using pre-defined key words to define each symptom. The proportion of clinic visits with impaired function detected by PROMIS was compared to proportion of clinic visits with symptom documented by clinician using chi square tests. Results: Forty children participated in the study. The mean age of study participants was 11.7 years (SD 4.7). Fifty-eight percent of the patients were male and 60% of patients had leukemia or lymphoma. Paired PRO data/clinician documentation was available for 150 visits. The mean number of clinic visits per study patient was 3.75 (range 2-5). Patients demonstrated impaired function on PROMIS related to any symptom measured at 24% of clinic visits. For all clinic visits at which PROMIS detected impaired function, the symptom was documented by the clinician only 20% of the time (p<0.0001). Mobility: When impaired function was detected by PROMIS, concerns related to mobility were documented by the clinician only 20% of the time (p<0.0001) (figure 1). Pain: When impaired function due to pain was detected by PROMIS, pain was documented by the clinician 38% of the time (p<0.0001) (figure 1). Fatigue: When impaired function due to fatigue was detected by PROMIS, fatigue was documented by the clinician only 20% of the time (p<0.0001) (figure 1). Anxiety: When impaired function due to anxiety was detected by PROMIS, anxiety was documented by the clinician at 0% of the visits (p<0.0001) (figure 1). Depressive symptoms: When impaired function due to depressive symptoms were detected by PROMIS, depressive symptoms were documented by the clinician only 7% of the time (p<0.0001) (figure 1). Conclusion: Symptoms causing significant impact on patient function as detected by PROs are poorly detected and documented by standard clinician interview. These data demonstrate the natural limitations of clinician interview to illicit the true impact of symptoms on patients' lives and the likelihood that clinicians are unaware of the impact of disease and treatment on individuals and their function. The discrepancies in detection of this burden by current practice highlight opportunities to use PRO data to supplement clinical practice. Disclosures Panepinto: HRSA, NIH: Research Funding; NKT Therapeutics, Inc: Consultancy.

scholarly journals A quasi-experimental, mixed-methods evaluation of the impact of transitioning to remote clinic visits in a smoking cessation trial during the SARS coronavirus-2 pandemic (Preprint)

2020 ◽  
Author(s):  
Martin C. Mahoney ◽  
Eunhee Park ◽  
Nicolas J Schlienz ◽  
CeCe Duerr ◽  
Larry W. Hawk
Keyword(s):  
Smoking Cessation ◽  
Completion Rate ◽  
Similar Time ◽  
Biospecimen Collection ◽  
Optimal Mix ◽  
Quasi Experimental ◽  
Rapid Transition ◽  
Conducting Research ◽  
The Impact ◽  
Clinic Visits

BACKGROUND The SARS-2-coronavirus (aka covid-19) pandemic caused disruptions in ongoing clinical trials and likely accelerated interest in conducting research studies remotely. OBJECTIVE A quasi-experimental, mixed method approach was utilized to examine the opinions and experiences of participants enrolled in an on-going clinical trial of smoking cessation who were required to change from in-person clinic visits to remote visits using video or phone conferencing due to the covid-19 pandemic. METHODS For quantitative comparisons we used a quasi-experimental design, comparing a cohort of participants followed during the pandemic (n=23, covid-19 cohort) to a comparable cohort of participants followed over a similar time period in calendar years 2018 & 2019 (n=51, pre-covid-19 cohort) to examine rates for completion of scheduled visits and biospecimen collection. For the qualitative component, interviews were conducted with participants who experienced the transition from “in-person” to “remote visits”. RESULTS Participants in the covid-19 cohort completed an average of 83.6% of remote clinic visits, which was not significantly different than the in-person completion rate of 89.8% in the pre-covid-19 cohort. Participants in the covid-19 cohort returned an average of 93.2% of salvia specimens for remote clinic visits completed, which was not significantly different than the in-person saliva specimen completion rate of 100%) in the pre-covid-19 cohort. Two broad themes emerged from the qualitative data: 1) the benefits of remote visits and 2) the challenges of remote counseling compared to in-person counseling. Despite limited experience with telehealth prior to this transition, most expressed a willingness to engage in remote visits in the future. CONCLUSIONS Even in the context of a rapid transition from in-person to remote visits necessitated by the covid-19 pandemic, rates of visit completion and return of biospecimens remained high. Participants were generally accepting of the transition. Further research is needed to identify the optimal mix of in-person and remote visits beyond the pandemic context and to better understand how these changes might impact study outcomes. CLINICALTRIAL This research was supported in part by the National Cancer Institute (R01 CA206193); additional research infrastructure support was provided by the National Center for Advancing Translational Sciences/NIH (UL1TR001412) to the University at Buffalo.

Feasibility of a clinic-based central line care teach-back program for pediatric oncology families.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 183-183
Author(s):  
Chris Ivette Wong Quiles ◽  
Marie D Desrochers ◽  
Riley M Mahan ◽  
Kristen Graham ◽  
Margaret Brill-Conway ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Culture Change ◽  
Best Practice ◽  
Language Change ◽  
Bloodstream Infections ◽  
Central Line ◽  
Quality Improvement Initiative ◽  
Targeted Interventions ◽  
The Impact ◽  
Clinic Visits

183 Background: Pediatric oncology (PO) patients with central lines (CLs) are at high risk for CL associated bloodstream infections (CLABSI), which increase morbidity, mortality, and costs. A large portion of ambulatory CL care in the home is provided by families who often have limited opportunities to develop the needed skills and adhere to best practice line care. Methods: A pilot quality improvement initiative was undertaken from 5/2015-6/2016 to develop a coaching program for families to demonstrate external CL care with a nurse during a routine clinic visit (teach-back), either on a simulation model or the patient. Tests of change were implemented to add teach-backs during routine clinic visits and ensure teach-back documentation in the medical record. Initial steps included assessing family interest in teach-backs by conducting surveys about CL care at home and unstructured incorporation into routine care by existing clinic nursing staff. After assessment of the pilot phase, targeted interventions started April 2016 including dedicated staff for scheduling, tracking, and performing teach-backs during routine clinic visits; culture change including an expectation that all families would participate and on-going staff education about the program; language change to increase participation by avoiding family perception of being tested; and incentives (gift-card raffle) for nurses to provide coaching. Results: Before April 2016, less than 25% of families participated due to a combination of family refusal; lack of nursing availability, space, or time; and inability to approach prior to line removal. In April 2016, 52% of families participated, reaching 90% by June 2016. Informal feedback from both staff and patient/family participants suggested increased job satisfaction by nurses and wide acceptance by all. In addition, many families participated in multiple teach-back sessions to improve line care skills. Conclusions: A CL teach-back program in a busy ambulatory PO clinic is feasible, but requires dedicated resources and culture change. Ongoing improvements are in place to ensure sustainability of the program and measure the impact on ambulatory CLABSI rate and family distress and line care skills.

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