scholarly journals Evaluating the Effectiveness of NoteAid in a Community Hospital Setting: Randomized Control Trial (Preprint)

2020 ◽  
Author(s):  
John P. Lalor ◽  
Wen Hu ◽  
Matthew Tran ◽  
Hao Wu ◽  
Kathleen M. Mazor ◽  
...  
Keyword(s):  
Community Hospital ◽  
Hospital Setting ◽  
Amazon Mechanical Turk ◽  
Average Score ◽  
Web Based ◽  
Low Health Literacy ◽  
Education Levels ◽  
Randomized Control ◽  
Lower Education ◽  
Hospital Sample

BACKGROUND Interventions to define medical jargon have been shown to improve Electronic Health Record (EHR) note comprehension among crowdsourced participants on Amazon Mechanical Turk (AMT). However, AMT participants may not be representative of the general population nor patients who are most at-risk for low health literacy. OBJECTIVE In this work we assess the efficacy of an intervention (NoteAid) on EHR note comprehension for participants in a community hospital setting. METHODS Participants were recruited from Lowell General Hospital (LGH), a community hospital in Massachusetts, to take the ComprehENotes test, a web-based test of EHR note comprehension. Participants were randomly assigned to control (85) or intervention (89) groups to take the test without or with NoteAid, respectively. For comparison, we used a sample of 200 participants recruited from AMT to take the ComprehENotes test (100 control and 100 intervention). RESULTS 174 participants were recruited from LGH, 200 participants were recruited from AMT. Participants in both intervention groups (community hospital and AMT) scored significantly higher than participants in the control groups (P < 0.001). The average score for the community hospital participants was significantly lower than the average score for the AMT participants (P < 0.001), consistent with the lower education levels in the community hospital sample. Education level had a significant effect on scores for the community hospital participants (P < 0.0005). CONCLUSIONS Use of NoteAid was associated with significantly improved EHR note comprehension in both community hospital and AMT samples. Our results demonstrate the generalizability of ComprehENotes as a test of EHR note comprehension and the effectiveness of NoteAid for improving EHR note comprehension.

scholarly journals Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study

2020 ◽  
Vol 8 (1) ◽  
pp. 1-100 ◽  
Author(s):  
John Young ◽  
Claire Hulme ◽  
Andrew Smith ◽  
John Buckell ◽  
Mary Godfrey ◽  
...  
Keyword(s):  
Economies Of Scale ◽  
Community Hospital ◽  
Hospital Ward ◽  
Intermediate Care ◽  
Community Hospitals ◽  
Web Based ◽  
Emergency Admissions ◽  
Hospital Wards ◽  
Insight Into ◽  
Hospital Sample

Background Community hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance. Objectives (1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5). Methods Study 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of < 24 hours) and the National Audit of Intermediate Care. Results Community hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [http://mocha.nhsbenchmarking.nhs.uk/ (accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions. Limitations The econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample. Conclusions The results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale. Future work How less efficient hospitals might reduce costs and sustain quality requires further research. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

Penerapan Model Pembelajaran Problem Based Learning dalam Pembelajaran Matematika di Kelas VIII SMPN 28 Padang

2017 ◽  
Vol 1 (2) ◽  
pp. 225-236
Author(s):  
Andi Susanto ◽  
Sony Ariadi
Keyword(s):  
High School ◽  
Problem Solving ◽  
Junior High School ◽  
Problem Based Learning ◽  
Average Score ◽  
Control Group ◽  
Learning Problem ◽  
Math Ability ◽  
Class Viii ◽  
Randomized Control

This reseach is aimed at knowing the students ability in both solving the math problem and connection those who are taught by Problem Based Learning at class VIII of the Junior High school 28 Padang 2017/2018. This research is categorized as quasy Experimental Research, by using Randomized Control Group Only Design. After implementing the Problem Based Leaning, the student was directly given the test as the result showed that the score  of the student who belong to the experimental class in  problem solving recorded as 74,00 while those who were in the control class only refers to 72,30. The test average score on the experimental class in term of math connection ability was 68,73; while in the control class recorded as 62,43. The T- Test showed that T-Table equals to 1,64 with the degree of reliability 95% . This fact reveals that the students’ ability in solving the problem after being taught through Problem Based Learning is higher than in control class with T-count equals to 3,71; while their connection math ability through Problem Based Learning Model in the Experimental Class is higher than control with T-count 2.17.Keywords: Problem Based Learning, problem solving, mathematics connection

The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

Web-based interventions aimed at improving the mental health effects of home caregivers for dementia: Meta-analysis (Preprint)

2019 ◽  
Author(s):  
Hui Feng ◽  
Yinan Zhao ◽  
Mingyue Hu ◽  
Hengyu Hu ◽  
Hui Li ◽  
...  
Keyword(s):  
Mental Health ◽  
Meta Analysis ◽  
The Elderly ◽  
Anxiety Symptoms ◽  
Average Score ◽  
Physical And Mental Health ◽  
Web Based ◽  
Negative Results ◽  
Cochrane Database ◽  
The Web

BACKGROUND Dementia is one of the major cause of disability and dependency among the elderly worldwide, and there are general psychological distresses among caregivers in dementia, such as depression and anxiety symptoms. The physical and mental health of the caregiver is a prerequisite and a promise to help the elderly stay alive and promote health. Web-based interventions can provide for a more convenient and efficient support and education, OBJECTIVE The purpose of this study was to examine the effect of internet-based interventions on mental health outcomes of family caregivers with dementia, and exploring which components of the web-based interventions play an important role.which are likely to reduce caregivers’ negative outcomes associated with care. METHODS A comprehensive literature search was conducted on PubMed, Embase, PsycINFO, Cochrane Database and CINAHL by using relevant terms such as web-based and caregiver as keywords, covering all studies published before June 2018. Two reviewers independently reviewed all published abstracts, according to the established inclusion and exclusion criteria ，we extracted the information about participants, interventions and results, respectively, and reviewed the quality of articles on the methods of randomized trials using the approach recommended by the Cochrane Handbook for systematic review for intervention. RESULTS A total of 815 caregivers participated in 6 articles, and 4 of the studies use depression as an outcome, according to the research after different interventions based on network after the intervention, depression scores average drop of 0.23 (95%CI -0.38 to -0.07, p<0.01), 2 studies show caregivers anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI -0.50 to -0.14, p< 0.01), but in terms of coping, pain and stress, the web-based interventions have shown a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve mental health of carers. CONCLUSIONS Internet-based interventions were generally effective in reducing anxiety and depression in dementia carers, although negative results were found in some studies. But in terms of burden and stress, further research is needed.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

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