scholarly journals The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review (Preprint)

2018 ◽  
Author(s):  
Gro Berntsen ◽  
Frode Strisland ◽  
Kristian Malm-Nicolaisen ◽  
Berglind Smaradottir ◽  
Rune Fensli ◽  
...  
Keyword(s):  
Care Delivery ◽  
Care Pathway ◽  
Disease Process ◽  
Evaluation Methodology ◽  
Care Plan ◽  
Care Utilization ◽  
Design Quality ◽  
Quality Health Care ◽  
Patient Reported

BACKGROUND There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. OBJECTIVE This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes. METHODS We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects. RESULTS Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects. CONCLUSIONS Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support.

scholarly journals Factors related to perceived continuity of care in hospitalized cardiac patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Safstrom ◽  
T.J Jaarsma ◽  
L.N Nordgren ◽  
M.L Liljeroos ◽  
A.S Stomberg
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Perceived Control ◽  
Care Utilization ◽  
Funding Source ◽  
Patient Reported

Abstract Background Since healthcare systems are increasingly complex and often fragmented, continuity of care after hospitalization is a priority to increase patient safety and satisfaction. Aim Describe factors related to continuity of care in patients hospitalized due to cardiac conditions. Methods This cross-sectional multicenter study enrolled patients 6 weeks after hospitalization due to cardiac conditions. A total of 993 patients were included (mean age 72.2 (SD 10.4), males 66%) with AMI (35%), AF (25%), angina (21%) and HF (17.3%). Patients completed the Patient Continuity of Care Questionnaire, a questionnaire based on the definition that continuity of care is “the extent to which a series of health care services is experienced as connected and coherent and is consistent with a patient's health needs and personal circumstances”. The total score of the questionnaire ranges from 6 to 30, higher score indicating higher continuity and a score <24 indicating insufficient continuity. Cronbach's alpha on the total PCCQ was 0.94. Correlations between PCCQ and quality of life, depression, anxiety, perceived control and health care utilization were estimated using spearman rang correlation. Results Insufficient continuity of care ranged between 47% to 59% in the different diagnosis groups, which the highest continuity in the AMI group and lowest in patients with atrial fibrillation. In patients hospitalized due to AMI (n=355, mean age 71 (± 11), 70% men), continuity of care was related to higher perceived control, higher quality of life, a good financial situation, being a man, no symptoms of anxiety or depression (ᚹ range 0.17–0.26 p≤0.002). A low score on the PCCQ were associated with follow-up visit to a nurse in primary care after hospitalization (ᚹ −0.12 p=0.033). In patients hospitalized due to angina (n=210, mean age 73 (± 9), 74% men), continuity of care was related to higher perceived control, higher quality of life and no depressive symptoms (ᚹ range between 0.20 and 0.26 p=0.005). In patients with AF, (n=255, mean age 71 (± 10.), 58% men), continuity of care was related to having had contact by telephone with a nurse-led AF clinic, higher perceived control, higher quality of life and not being depressed (ᚹ range between 0.14–0.25 p=0.03). In patients with HF, (n=173, mean age 77 (±8) 59% men), continuity was related to male ender, younger age, follow-up in a nurse-led HF clinic and not being anxious (ᚹ range between 0.16 and 0.22 p=0.004–0.047). Low total score on PCCQ correlated to having had telephone contact with nurse in primary care (ᚹ −0.24 p=0.002). Conclusion Almost half of all patient reported insufficient continuity of care. Perceived control, quality of life, and symptoms of depression were related to higher continuity of care in all diagnose groups except heart failure. Further, there was a correlation between continuity and follow-up visits or contact by telephone with nurse-led clinics in all diagnose groups except angina. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council of Southeast Sweden, Centre for Clinical Research Sörmland

scholarly journals Video-Based Telemedicine for Kidney Disease Care

2021 ◽  
Vol 16 (12) ◽  
pp. 1813-1823
Author(s):  
Ann Young ◽  
Ani Orchanian-Cheff ◽  
Christopher T. Chan ◽  
Ron Wald ◽  
Stephanie W. Ong
Keyword(s):  
Health Care ◽  
Kidney Disease ◽  
Systematic Reviews ◽  
Care Delivery ◽  
Case Series ◽  
Care Utilization ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Content Type ◽  
Patient Reported

Background and objectivesVideo-based telemedicine provides an alternative health care delivery model for patients with CKD. The objective was to provide an overview of the available evidence on the implementation and outcomes of adopting video-based telemedicine in nephrology.Design, setting, participants, & measurementsMEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL were searched in December 2019 and again in January 2021 for studies using video-based telemedicine for adults across the spectrum of kidney disease. Study types included peer-reviewed clinical trials, observational studies, and descriptive studies available in full text. Search results were independently screened by two authors, who then independently reviewed and extracted data from the eligible studies. Results were synthesized in tabular format, summarizing study characteristics by area within nephrology; the video-based interventions used; and clinical, health care utilization, and patient-reported outcomes.ResultsAfter reviewing 1870 unique citations, 24 studies were included (four randomized controlled trials, six cohort studies, five pre-post intervention studies, seven case series, and two qualitative studies). Video-based technology was used to facilitate care across all stages of CKD. Although earlier studies used a range of institution-specific technologies that linked main hospital sites to more remote health care locations, more recent studies used technology platforms that allowed patients to receive care in a location of their choice. Video-based care was well received, with the studies reporting high patient satisfaction and acceptable clinical outcomes.ConclusionsVideo-based telemedicine is being used for kidney care and has evolved to be less reliant on specialized telemedicine equipment. As its use continues to grow, further primary studies and systematic reviews of outcomes associated with the latest innovations to video-based care in nephrology can address knowledge gaps, such as approaches to sustainable integration and minimization of barriers to access.

Nurse, oncologist, and patient impressions of electronic symptom monitoring via patient-reported outcomes in community oncology practices: Qualitative results from the U.S. national PRO-TECT trial (AFT-39, NCT03249090).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7044-7044
Author(s):  
Ethan M. Basch ◽  
Randall Teal ◽  
Amylou C. Dueck ◽  
Jennifer Jansen ◽  
Sydney Henson ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Patient Reported Outcomes ◽  
Positive Impact ◽  
Care Delivery ◽  
Routine Care ◽  
Office Visits ◽  
Symptom Monitoring ◽  
Community Oncology ◽  
Patient Reported

7044 Background: There is growing interest to implement electronic patient-reported outcomes in oncology practices for symptom monitoring. It is not well known what nurse, physician, and patient impressions of benefits, acceptability, and challenges are in routine care use. Methods: PRO-TECT is an ongoing U.S. national trial including 26 community oncology practices across 15 states that implemented PRO symptom monitoring [NCT03249090]. Patients complete weekly PROs between visits, nurses receive alerts for severe/worsening symptoms, and oncologists review PROs at office visits. Interviews were conducted with 147 stakeholders including nurses (N = 46), oncologists (N = 27), data managers (N = 15), and patients (N = 59). Each stakeholder group had different interview guides with overlapping topics to explore experiences with the PRO system. Interviews lasted 15-60 minutes, were digitally recorded, transcribed, and entered into a qualitative analysis software program. A codebook was developed from the research questions, interview guides, and discussions with the project team. Standardized coding methods were applied, with transcripts double coded for thematic analysis. Feedback surveys were also completed by nurses (N = 57), oncologists (N = 38), and patients (N = 435). Results: Key benefits perceived across stakeholder groups included increased patient self-awareness of symptoms; improved direct communication of patients with care teams; more open and honest conveying of symptom experiences; ability to track symptoms over time; and increased involvement of patients in their own care. Most stakeholders felt PRO symptom monitoring had a positive impact on quality of care delivery, and believed benefits of PROs outweighed necessary staff efforts. Challenges included additional work by nurses to review and respond to alerts, staff turnover requiring retraining, and limited time of oncologists. In the survey, 39/56 (70%) nurses felt the PRO system improved quality of care; 27/33 (82%) oncologists noted PROs were useful for team discussions and care delivery; and 320/434 (74%) patients agreed that weekly PRO reporting improved discussions with their care team. Conclusions: Clinicians and patients perceived weekly PRO symptom monitoring between visits to be valuable despite added staff effort. Results of additional analyses are forthcoming. Clinical trial information: NCT03249090 .

Improvement in Quality of Life Following Operative Correction of Midtarsal Charcot Foot Deformity

2018 ◽  
Vol 39 (7) ◽  
pp. 808-811 ◽  
Author(s):  
Ellen Kroin ◽  
Edwin O. Chaharbakhshi ◽  
Adam Schiff ◽  
Michael S. Pinzur
Keyword(s):  
Quality Of Life ◽  
Activity Index ◽  
Case Series ◽  
Disease Process ◽  
Charcot Foot ◽  
Operative Correction ◽  
Therapeutic Footwear ◽  
Operative Reconstruction ◽  
Patient Reported

Background: Patients with Charcot foot arthropathy report a poor quality of life following the development of deformity. Their quality of life is often not improved with “successful” historic accommodative treatment. There is increased current interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population. Methods: Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1 year following the surgery. One patient died during the year following surgery from unrelated causes. Results: There was an 11.5-point (95% confidence interval [CI]: –19.7 to −3.2) decrease in the standardized functional index ( P = .01). Similarly, there was a 12.4-point (95% CI: –22.5 to −2.3) decrease in the standardized bother index ( P = .02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: –30.5 to −8.6, P = .002), and there was a 14.7-point (95% CI: –24.1 to −5.3) decrease in the standardized emotion index ( P = .004). There was no meaningful change in the standardized arm/hand index ( P = .81). Conclusion: The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in operative correction to allow the use of commercially available therapeutic footwear. Level of Evidence: Level IV, case series.

ASCO PRO workgroup update: Patient-reported outcome measures as a quality indicator.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 276-276 ◽  
Author(s):  
Angela M. Stover ◽  
Anne C. Chiang ◽  
Ethan M. Basch
Keyword(s):  
Quality Of Care ◽  
Underserved Populations ◽  
Care Delivery ◽  
Symptom Control ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Validity And Reliability ◽  
Quality Metric ◽  
Patient Reported

276 Background: Although patient questionnaires are commonly used to assess healthcare experiences (e.g., satisfaction with care), patient-reported outcome (PRO) measures assessing symptoms and physical functioning have not conventionally been used for quality assessment. More typically, quality of care is measured with administrative data, such as hospital readmission rates. There is an opportunity to advance the science of quality measurement by integrating a patient-centered approach. Methods: ASCO established a multi-stakeholder PRO Workgroup (including extensive patient input) to develop and test PRO-based performance measures (PRO-PMs). The ASCO PRO Workgroup outlined three initial PRO-PMs to test for patients receiving moderately/highly emetogenic chemotherapy: 1) process: proportion self-reporting symptoms at, or within 2 weeks, of last visit; 2) outcome: proportion experiencing moderate/high levels of nausea; and 3) outcome: proportion reporting moderate/high pain. We will give an update on progress of the ASCO PRO Workgroup and outline next steps needed to implement PRO measures as a quality metric. Results: Three key methodological advancements are needed before PRO measures can be used as a quality metric. First, areas of cancer care delivery need to be identified that are important to patients when considering quality of care and are amenable to performance evaluation with PRO measures (e.g., symptom control). Second, existing PRO questionnaires need to be systematically identified and evaluated for potential quality use. The review should evaluate psychometric properties, validity and reliability, and feasibility for clinical use. Third, testing is needed in representative practice settings to iteratively refine: 1) logistical strategy for systematically collecting this information at the practice level; 2) approaches for minimizing missing data, particularly from underserved populations; and 3) adjustments for patient characteristics (case-mix). Conclusions: Methodological advancements are necessary before PRO measures can be implemented as a quality metric. PRO measures have the potential to provide quality assessments that are useful to patients making health care decisions.

scholarly journals Establishing a global quality of care benchmark report

2021 ◽  
Vol 27 (2) ◽  
pp. 146045822110157
Author(s):  
Fanny Sampurno ◽  
Justin Cally ◽  
Jacinta L Opie ◽  
Ashwini Kannan ◽  
Jeremy L Millar ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Outcome Measures ◽  
Large Scale ◽  
Best Practice ◽  
Response Rate ◽  
Care Delivery ◽  
Current Data ◽  
Data Display ◽  
Patient Reported

Background: The Movember funded TrueNTH Global Registry (TNGR) aims to improve care by collecting and analysing a consistent dataset to identify variation in disease management, benchmark care delivery in accordance with best practice guidelines and provide this information to those in a position to enact change. We discuss considerations of designing and implementing a quality of care report for TNGR. Methods: Eleven working group sessions were held prior to and as reports were being built with representation from clinicians, data managers and investigators contributing to TNGR. The aim of the meetings was to understand current data display approaches, share literature review findings and ideas for innovative approaches. Preferred displays were evaluated with two surveys (survey 1: 5 clinicians and 5 non-clinicians, 83% response rate; survey 2: 17 clinicians and 18 non-clinicians, 93% response rate). Results: Consensus on dashboard design and three data-display preferences were achieved. The dashboard comprised two performance summary charts; one summarising site’s relative quality indicator (QI) performance and another to summarise data quality. Binary outcome QIs were presented as funnel plots. Patient-reported outcome measures of function score and the extent to which men were bothered by their symptoms were presented in bubble plots. Time series graphs were seen as providing important information to supplement funnel and bubble plots. R Markdown was selected as the software program principally because of its excellent analytic and graph display capacity, open source licensing model and the large global community sharing program code enhancements. Conclusions: International collaboration in creating and maintaining clinical quality registries has allowed benchmarking of process and outcome measures on a large scale. A registry report system was developed with stakeholder engagement to produce dynamic reports that provide user-specific feedback to 132 participating sites across 13 countries.

scholarly journals Measuring Quality of Life Using Patient-Reported Outcomes in Real-World Metastatic Breast Cancer Patients: The Need for a Standardized Approach

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2308
Author(s):  
Marloes E. Clarijs ◽  
Jacob Thurell ◽  
Friedrich Kühn ◽  
Carin A. Uyl-de Groot ◽  
Elham Hedayati ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Metastatic Breast Cancer ◽  
Real World ◽  
Patient Reported Outcomes ◽  
Care Pathway ◽  
Clinical Care ◽  
Metastatic Breast ◽  
Patient Reported

Metastatic breast cancer (MBC) patients are almost always treated to minimize the symptom burden, and to prolong life without a curative intent. Although the prognosis of MBC patients has improved in recent years, the median survival after diagnosis is still only 3 years. Therefore, the health-related quality of life (HRQoL) should play a leading role in making treatment decisions. Heterogeneity in questionnaires used to evaluate the HRQoL in MBC patients complicates the interpretability and comparability of patient-reported outcomes (PROs) globally. In this review, we aimed to provide an overview of PRO instruments used in real-world MBC patients and to discuss important issues in measuring HRQoL. Routinely collecting symptom information using PROs could enhance treatment evaluation and shared decision-making. Standardizing these measures might help to improve the implementation of PROs, and facilitates collecting and sharing data to establish valid comparisons in research. This is a prerequisite to learn about how they could impact the clinical care pathway. In addition, the prognostic value of intensified PRO collection throughout therapy on survival and disease progression is promising. Future perspectives in the field of PROs and MBC are described.

Presbyterian Hospital of Dallas v. Harris: A Dubious Consequence of Piecemeal Health Care Legislation

1983 ◽  
Vol 9 (2) ◽  
pp. 205-224
Author(s):  
Deborah K. Berk
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Health Care Financing ◽  
Care Plan ◽  
Quality Health Care ◽  
Circuit Court ◽  
Presbyterian Hospital ◽  
Court Of Appeals ◽  
Quality Health ◽  
Judicial Policymaking

AbstractFor almost forty years, legislators have advocated comprehensive measures designed to assure Americans quality health care. Instead of implementing an integrated health care plan, Congress has intermittently enacted statutes which address specific health care delivery problems. At times the judiciary has stretched the ambit of existing health legislation in response to particular plaintiffs’ urgent claims. This Case Comment examines the dilemma of piecemeal legislation and judicial policymaking as exemplified by Presbyterian Hospital of Dallas v. Harris, a Fifth Circuit Court of Appeals health care financing decision whose outcome Congress has flatly rejected.

scholarly journals The Impact of Payer and Reimbursement Authorities Evidence Requirements on Healthcare Solution Design for Muscular Dystrophies

2020 ◽  
Author(s):  
Maximilian Lebmeier ◽  
Fleur Chandler ◽  
Josie Godfrey ◽  
Jonathan Dando
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Care Pathway ◽  
Standards Of Care ◽  
Optimal Care ◽  
Healthcare Decision Making ◽  
Key Stakeholders ◽  
Patient Reported ◽  
The Impact

For rare diseases that start early and are slowly degenerative, despite the desire to create solutions that benefit the patient, healthcare system realities can be prohibitive to generate an affordable and effective solution. The optimal care pathway for muscular dystrophy, similar to all degenerative diseases, would be a rapid and accurate diagnosis, pathophysiological confirmation and application of therapeutics that slowly replaces damaged tissue with healthy tissue, supported by adjuvant solutions that stimulate the tissue to repair and reduce inflammation and fibrosis. This would increase the lifespan and quality of life in an affordable way. For all diseases, two key stakeholders, the paying entity and the patient, fundamentally define whether revenue can be generated. Healthcare decision-making commissioners who agree to pay for the product and patient-reported outcomes jointly inform whether the intervention increases the quality of life related to existing standards of care and, therefore, if it should be paid for. This chapter explains why this has not yet happened and efforts initiated to correct this and addresses how the components and data used in this decision-making process could be updated, adapted and integrated into every stage of the development of solutions and how organisational innovation may enable the field.

scholarly journals Feasibility of a Patient-Reported Outcomes Quality of Life Instrument to Improve Care in Underserved, Ethnic Minority Cancer Patients

2019 ◽  
Author(s):  
Nandita Khera ◽  
Ian Komenaka ◽  
Gilbert Ramos ◽  
Briant Fruth ◽  
Waqas Arslan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ethnic Minority ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Spanish Version ◽  
Vulnerable Groups ◽  
Patient Reported ◽  
Patient Concerns

Abstract Background A better understanding of social determinants of health and psychosocial and economic sequelae of cancer for an ethnoculturally diverse population is needed. A Patient-Reported Outcomes Quality of Life (PROQOL) instrument has been developed to capture less commonly discussed patient concerns. We sought to adapt this instrument and pilot it in underserved, ethnic minority cancer patients at Maricopa Integrated Health System (MIHS) in Phoenix, AZ. Methods Two focus groups (FG) were conducted to understand patient perspectives of an adapted Spanish version of PROQOL. A revised version based on FG data was then piloted among patients on active cancer treatment. Patients also completed a Linear Analog Scale Assessment (from 1-10) for quality of life (QOL) and its domains. Results All participants in both FG (11/12 female) were Hispanic, with a median age of 53 years. Participants agreed that the domains covered in the PROQOL represented the most important psychosocial needs in their cancer continuum. No difficulty in understanding the individual domains or questions for delving deeper into each domain was noted. Median age of 34 pilot study participants (74% female, 79% Hispanic) was 48 years. 28/34 completed the Spanish version. The most common concerns were ‘Money’ (32%) and ‘Cancer Diagnosis, Treatment and Survivorship’ (32%). Median overall QOL was 8 (range 3-10). Conclusions PROQOL is feasible for systematic capture of patient concerns in underserved, ethnic minority cancer patients. A better understanding of these concerns can help design interventions to improve psychosocial outcomes for the vulnerable groups and decrease disparities in care delivery.

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