scholarly journals MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruyère Continuing Care: User-Centered Design and Feasibility Testing Study

10.2196/18169 ◽  
2020 ◽  
Vol 4 (9) ◽  
pp. e18169
Author(s):  
Chantal Backman ◽  
Anne Harley ◽  
Craig Kuziemsky ◽  
Jay Mercer ◽  
Liam Peyton
Keyword(s):  
Phase 1 ◽  
Health Care Team ◽  
Rehabilitation Program ◽  
Geriatric Rehabilitation ◽  
Phase 2 ◽  
User Centered Design ◽  
Web Based ◽  
Semistructured Interviews ◽  
User Centered

Background When older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers. Objective The overall objective was to develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home. Methods This study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of MyPath to Home. Baseline and follow-up surveys, as well as select semistructured interviews were conducted. Results In phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team. Conclusions We were successful at designing the MyPath to Home prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes. International Registered Report Identifier (IRRID) RR2-10.2196/11031

scholarly journals MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruyère Continuing Care: User-Centered Design and Feasibility Testing Study (Preprint)

2020 ◽  
Author(s):  
Chantal Backman ◽  
Anne Harley ◽  
Craig Kuziemsky ◽  
Jay Mercer ◽  
Liam Peyton
Keyword(s):  
Phase 1 ◽  
Health Care Team ◽  
Rehabilitation Program ◽  
Geriatric Rehabilitation ◽  
Phase 2 ◽  
User Centered Design ◽  
Web Based ◽  
Semistructured Interviews ◽  
User Centered

BACKGROUND When older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers. OBJECTIVE The overall objective was to develop and test the feasibility of a novel web-based application called <i>MyPath to Home</i> that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home. METHODS This study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of <i>MyPath to Home</i>. Baseline and follow-up surveys, as well as select semistructured interviews were conducted. RESULTS In phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team. CONCLUSIONS We were successful at designing the <i>MyPath to Home</i> prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes. INTERNATIONAL REGISTERED REPORT RR2-10.2196/11031

Applying User-Centered Design to Develop an Audit and Feedback Intervention for the Home Care Sector

2017 ◽  
Vol 29 (3) ◽  
pp. 148-160 ◽  
Author(s):  
Heather L. Colquhoun ◽  
Deborah Sattler ◽  
Christine Chan ◽  
Taheera Walji ◽  
Rachel Palumbo ◽  
...  
Keyword(s):  
Home Care ◽  
Care Management ◽  
Phase 1 ◽  
Audit And Feedback ◽  
Phase 2 ◽  
User Centered Design ◽  
User Testing ◽  
Home And Community Care ◽  
Semistructured Interviews ◽  
User Centered

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 ( n = 33) and Phase 2 ( n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management.

scholarly journals Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes (Preprint)

2019 ◽  
Author(s):  
Mandi L Klamerus ◽  
Laura J Damschroder ◽  
Jordan B Sparks ◽  
Sarah E Skurla ◽  
Eve A Kerr ◽  
...  
Keyword(s):  
Primary Care ◽  
Design Process ◽  
Phase 1 ◽  
Primary Care Providers ◽  
Medical Services ◽  
Second Phase ◽  
Phase 2 ◽  
User Centered Design ◽  
The Impact ◽  
User Centered

BACKGROUND Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that has become ingrained in current clinical practices and is being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front lines of clinical care: patients and their clinicians. Design approaches are a promising and innovative way to incorporate stakeholder needs, desires, and challenges to develop solutions to complex problems. OBJECTIVE This study aimed (1) to engage patients in a design process to develop high-level deintensification strategies for primary care (ie, strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) and (2) to engage both patients and primary care providers in further co-design to develop and refine the broad deintensification strategies identified in phase 1. METHODS We engaged stakeholders in design charrettes—intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem—focused on deintensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with 2 different groups of patients (phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of phase 1 patients (phase 2). Both phases included surveys and educational presentations related to deintensification. Phase 1 involved several design activities (mind mapping, business origami, and empathy mapping) to help patients gain a deeper understanding of the individuals involved in deintensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to deintensification and then to brainstorm solutions. The deintensification themes identified in phase 1 were used to guide phase 2. This second phase primarily involved 1 design activity (<italic>WhoDo</italic>). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support deintensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers. RESULTS A total of 35 patients participated in phase 1, and 9 patients and 7 clinicians participated in phase 2. The analysis of the deintensification strategies and survey data is currently underway. The results are expected to be submitted for publication in early 2020. CONCLUSIONS Health care interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. This study employed design charrettes, guided by a flexible user-centered design model, to bring clinicians and patients with differing backgrounds and with different expectations together to cocreate real-world solutions to the complex issue of deintensifying medical services.

scholarly journals Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care (The FACTS Study Phase II) After Surgical Abortion: User-Centered Design

10.2196/14558 ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. e14558
Author(s):  
Roopan Kaur Gill ◽  
Gina Ogilvie ◽  
Wendy V Norman ◽  
Brian Fitzsimmons ◽  
Ciana Maher ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Usability Testing ◽  
User Centered Design ◽  
Web Based ◽  
Postabortion Care ◽  
Technology Intervention ◽  
Surgical Abortion ◽  
User Centered

Background Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. Objective The objectives for this study were to: (1) develop a Web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the Web-based intervention for pilot testing. Methods The study design was based on the “development-evaluation-implementation” process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. Results We developed a comprehensive Web-based tool called myPostCare.ca, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to myPostCare.ca resources. The Web-based tool was refined based on usability testing results. Conclusions This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care.

scholarly journals Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care (The FACTS Study Phase II) After Surgical Abortion: User-Centered Design (Preprint)

2019 ◽  
Author(s):  
Roopan Kaur Gill ◽  
Gina Ogilvie ◽  
Wendy V Norman ◽  
Brian Fitzsimmons ◽  
Ciana Maher ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Usability Testing ◽  
User Centered Design ◽  
Web Based ◽  
Postabortion Care ◽  
Technology Intervention ◽  
Surgical Abortion ◽  
User Centered

BACKGROUND Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. OBJECTIVE The objectives for this study were to: (1) develop a Web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the Web-based intervention for pilot testing. METHODS The study design was based on the “development-evaluation-implementation” process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. RESULTS We developed a comprehensive Web-based tool called myPostCare.ca, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to myPostCare.ca resources. The Web-based tool was refined based on usability testing results. CONCLUSIONS This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care.

scholarly journals A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach

10.2196/11473 ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. e11473 ◽  
Author(s):  
Mahsa Honary ◽  
Naomi Ruth Fisher ◽  
Roisin McNaney ◽  
Fiona Lobban
Keyword(s):  
Bipolar Disorder ◽  
Computer Literacy ◽  
Mental Health Problems ◽  
Phase 1 ◽  
Online Support ◽  
Heuristic Evaluation ◽  
User Centered Design ◽  
Web Based ◽  
Perceived Usability ◽  
User Centered

BackgroundRelatives of people experiencing bipolar mood episodes or psychosis face a multitude of challenges (eg, social isolation, limited coping strategies, and issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, to design tools that are useful to relatives, we first need to understand their needs.ObjectiveThe aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder.MethodsWe engaged relatives of people with experiences of bipolar disorder or psychosis in workshops to identify their needs and design requirements for developing a Web-based version of a paper-based toolkit. We used a 2-phase qualitative approach to explore relatives’ views on content, design, and functionalities, which are considered to be engaging and useful in a Web-based intervention. In phase 1, we consulted 24 relatives in 2 workshops to better understand their existing support infrastructure, their barriers for accessing support, unmet needs, and relatives’ views on online support. On the basis of the results of these workshops, we developed a set of design considerations to be explored in a smaller workshop. Workshop 3 then involved working with 2 digitally literate relatives to design a usable and acceptable interface for our Web-based toolkit. Finally, in phase 2, we conducted a heuristic evaluation to assess the usability of the toolkit.ResultsOur findings indicated that relatives require technologies that (1) they can place their trust in, particularly when discussing a highly sensitive topic, (2) enable learning from the lived experiences of others while retaining confidentiality, and (3) they can work through at their own pace in a personalized manner.ConclusionsOur study highlights the need for providing a trustworthy, supportive tool where relatives can engage with people who have similar experiences to their own. Our heuristic evaluation showed promise in terms of perceived usability of the REACT Web-based intervention. Through this work, we emphasize the need to involve stakeholders with various characteristics, including users with limited computer literacy or experience in online support.

scholarly journals Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes

10.2196/15618 ◽  
2019 ◽  
Vol 8 (11) ◽  
pp. e15618 ◽  
Author(s):  
Mandi L Klamerus ◽  
Laura J Damschroder ◽  
Jordan B Sparks ◽  
Sarah E Skurla ◽  
Eve A Kerr ◽  
...  
Keyword(s):  
Primary Care ◽  
Design Process ◽  
Phase 1 ◽  
Primary Care Providers ◽  
Medical Services ◽  
Second Phase ◽  
Phase 2 ◽  
User Centered Design ◽  
The Impact ◽  
User Centered

Background Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that has become ingrained in current clinical practices and is being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front lines of clinical care: patients and their clinicians. Design approaches are a promising and innovative way to incorporate stakeholder needs, desires, and challenges to develop solutions to complex problems. Objective This study aimed (1) to engage patients in a design process to develop high-level deintensification strategies for primary care (ie, strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) and (2) to engage both patients and primary care providers in further co-design to develop and refine the broad deintensification strategies identified in phase 1. Methods We engaged stakeholders in design charrettes—intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem—focused on deintensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with 2 different groups of patients (phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of phase 1 patients (phase 2). Both phases included surveys and educational presentations related to deintensification. Phase 1 involved several design activities (mind mapping, business origami, and empathy mapping) to help patients gain a deeper understanding of the individuals involved in deintensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to deintensification and then to brainstorm solutions. The deintensification themes identified in phase 1 were used to guide phase 2. This second phase primarily involved 1 design activity (WhoDo). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support deintensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers. Results A total of 35 patients participated in phase 1, and 9 patients and 7 clinicians participated in phase 2. The analysis of the deintensification strategies and survey data is currently underway. The results are expected to be submitted for publication in early 2020. Conclusions Health care interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. This study employed design charrettes, guided by a flexible user-centered design model, to bring clinicians and patients with differing backgrounds and with different expectations together to cocreate real-world solutions to the complex issue of deintensifying medical services. International Registered Report Identifier (IRRID) RR1-10.2196/15618

scholarly journals A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach (Preprint)

2018 ◽  
Author(s):  
Mahsa Honary ◽  
Naomi Ruth Fisher ◽  
Roisin McNaney ◽  
Fiona Lobban
Keyword(s):  
Bipolar Disorder ◽  
Computer Literacy ◽  
Mental Health Problems ◽  
Phase 1 ◽  
Online Support ◽  
Heuristic Evaluation ◽  
User Centered Design ◽  
Web Based ◽  
Perceived Usability ◽  
User Centered

BACKGROUND Relatives of people experiencing bipolar mood episodes or psychosis face a multitude of challenges (eg, social isolation, limited coping strategies, and issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, to design tools that are useful to relatives, we first need to understand their needs. OBJECTIVE The aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder. METHODS We engaged relatives of people with experiences of bipolar disorder or psychosis in workshops to identify their needs and design requirements for developing a Web-based version of a paper-based toolkit. We used a 2-phase qualitative approach to explore relatives’ views on content, design, and functionalities, which are considered to be engaging and useful in a Web-based intervention. In phase 1, we consulted 24 relatives in 2 workshops to better understand their existing support infrastructure, their barriers for accessing support, unmet needs, and relatives’ views on online support. On the basis of the results of these workshops, we developed a set of design considerations to be explored in a smaller workshop. Workshop 3 then involved working with 2 digitally literate relatives to design a usable and acceptable interface for our Web-based toolkit. Finally, in phase 2, we conducted a heuristic evaluation to assess the usability of the toolkit. RESULTS Our findings indicated that relatives require technologies that (1) they can place their trust in, particularly when discussing a highly sensitive topic, (2) enable learning from the lived experiences of others while retaining confidentiality, and (3) they can work through at their own pace in a personalized manner. CONCLUSIONS Our study highlights the need for providing a trustworthy, supportive tool where relatives can engage with people who have similar experiences to their own. Our heuristic evaluation showed promise in terms of perceived usability of the REACT Web-based intervention. Through this work, we emphasize the need to involve stakeholders with various characteristics, including users with limited computer literacy or experience in online support.

scholarly journals Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism

2021 ◽  
Vol 5 (1) ◽  
pp. e000700
Author(s):  
Carrie Allison ◽  
Fiona E Matthews ◽  
Liliana Ruta ◽  
Greg Pasco ◽  
Renee Soufer ◽  
...  
Keyword(s):  
Phase 1 ◽  
Autism Spectrum ◽  
Population Screening ◽  
Diagnostic Assessment ◽  
Test Accuracy ◽  
Multiple Time ◽  
Phase 2 ◽  
Time Points ◽  
Screening Study

ObjectiveThis is a prospective population screening study for autism in toddlers aged 18–30 months old using the Quantitative Checklist for Autism in Toddlers (Q-CHAT), with follow-up at age 4.DesignObservational study.SettingLuton, Bedfordshire and Cambridgeshire in the UK.Participants13 070 toddlers registered on the Child Health Surveillance Database between March 2008 and April 2009, with follow-up at age 4; 3770 (29%) were screened for autism at 18–30 months using the Q-CHAT and the Childhood Autism Spectrum Test (CAST) at follow-up at age 4.InterventionsA stratified sample across the Q-CHAT score distribution was invited for diagnostic assessment (phase 1). The 4-year follow-up included the CAST and the Checklist for Referral (CFR). All with CAST ≥15, phase 1 diagnostic assessment or with developmental concerns on the CFR were invited for diagnostic assessment (phase 2). Standardised diagnostic assessment at both time-points was conducted to establish the test accuracy of the Q-CHAT.Main outcome measuresConsensus diagnostic outcome at phase 1 and phase 2.ResultsAt phase 1, 3770 Q-CHATs were returned (29% response) and 121 undertook diagnostic assessment, of whom 11 met the criteria for autism. All 11 screened positive on the Q-CHAT. The positive predictive value (PPV) at a cut-point of 39 was 17% (95% CI 8% to 31%). At phase 2, 2005 of 3472 CASTs and CFRs were returned (58% response). 159 underwent diagnostic assessment, including 82 assessed in phase 1. All children meeting the criteria for autism identified via the Q-CHAT at phase 1 also met the criteria at phase 2. The PPV was 28% (95% CI 15% to 46%) after phase 1 and phase 2.ConclusionsThe Q-CHAT can be used at 18–30 months to identify autism and enable accelerated referral for diagnostic assessment. The low PPV suggests that for every true positive there would, however, be ~4–5 false positives. At follow-up, new cases were identified, illustrating the need for continued surveillance and rescreening at multiple time-points using developmentally sensitive instruments. Not all children who later receive a diagnosis of autism are detectable during the toddler period.

scholarly journals MP09: Canadian Community Utilization of Stroke Prevention Pilot Study-Emergency Department (C-CUSP ED)

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S68 ◽  
Author(s):  
R. Parkash ◽  
K. Magee ◽  
M. McMullen ◽  
M.B. Clory ◽  
M. D’Astous ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Phase 1 ◽  
Retrospective Chart Review ◽  
Phase 2 ◽  
Phase 3 ◽  
Three Phase ◽  
Rigorous Study ◽  
The Mean ◽  
Prior Risk

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia affecting 1-2% of the population. Oral anticoagulation (OAC) reduces stroke risk by 60-80% in AF patients, but only 50% of indicated patients receive OAC. Many patients present to the ED with AF due to arrhythmia symptoms, however; lack of OAC prescription in the ED has been identified as a significant gap in the care of AF patients. Methods: This was a multi-center, pragmatic, three-phase before-after study, in three Canadian sites. Patients who presented to the ED with electrocardiographically (ECG) documented, nonvalvular AF and were discharged home were included. Phase 1 was a retrospective chart review to determine OAC prescription of AF patients in each ED; Phase 2 was a low-intensity knowledge translation intervention where a simple OAC-prescription tool for ED physicians with subsequent short-term OAC prescription was used, as well as an AF patient education package and a letter to family physicians; phase 3 incorporated Phase 2 interventions, but added immediate follow-up in a community AF clinic. The primary outcome of the study was the rate of new OAC prescriptions at ED discharge in AF patients who were OAC eligible and were not on OAC at presentation. Results: A total of 632 patients were included from June, 2015-November, 2016. ED census ranged from 30000-68000 annual visits. Mean age was 71±15, 67±12, 67±13 years, respectively. 47.5% were women, most responsible ED diagnosis was AF in 75.8%. The mean CHA2DS2-VASc score was 2.6±1.8, with no difference amongst groups. There were 266 patients eligible for OAC and were not on this at presentation. In this group, the prescription of new OAC was 15.8% in Phase 1 as compared to 54% and 47%, in Phases 2 and 3, respectively. After adjustment for center, components of the CHA2DS2-VASc score, prior risk of bleeding and most responsible ED diagnosis, the odds ratio for new OAC prescription was 8.0 (95%CI (3.5,18.3) p&lt;0.001) for Phase 3 vs 1, and 10.0 (95%CI (4.4,22.9) p&lt;0.001), for Phase 2 vs 1). No difference in OAC prescription was seen between Phases 2 and 3. Conclusion: Use of a simple OAC-prescription tool was associated with an increase in new OAC prescription in the ED for eligible patients with AF. Further testing in a rigorous study design to assess the effect of this practice on stroke prevention in the AF patients who present to the ED is indicated.

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