A Blueprint for the Conduct of Large, Multi-Site Trials in Telemedicine (Preprint)

2021 ◽  
Author(s):  
Patricia Commiskey ◽  
April W Armstrong ◽  
Tumaini Rucker Coker ◽  
Earl Ray Dorsey ◽  
John Fortney ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Stroke Care ◽  
Lessons Learned ◽  
Patient Centered ◽  
Implementation Challenges ◽  
Home Based ◽  
Family Based ◽  
Key Aspects

BACKGROUND Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes, despite the wide variability in results. OBJECTIVE Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. METHODS This viewpoint presents relevant challenges and solutions for conducting multi-site telemedicine trials using seven ongoing and completed studies funded by the Patient Centered Outcomes Research Institute (PCORI) portfolio of large multi-site trials to highlight the challenges in implementing telemedicine trials. RESULTS Implementation challenges related to clinical, informatics, regulatory, legal, quality and billing were identified and described. CONCLUSIONS Lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multi-site telemedicine trials. CLINICALTRIAL NCT02358135: Improving Specialty-Care Delivery in Chronic Skin Diseases (PI: AWArmstrong) NCT02396576: Using Telehealth to Deliver Developmental, Behavioral, and Mental Health Services in Primary Care Settings for Children in Underserved Areas (PI: TRCoker) NCT02038959: Connect.Parkinson (PI: RDorsey) NCT04000971: C3FIT (Coordinated, Collaborative, Comprehensive, Family-based, Integrated, Technology-enabled Care) Stroke Care Trial (PI: KGaines) NCT03694431: Noninferiority Comparative Effectiveness Trial of Home-Based Palliative Care (HomePal) Trial (PI: HNguyen, KMularski) NCT04153864: SUMMIT (Scaling Up Maternal Mental healthcare by Increasing access to Treatments) Trial (PI: DRSingla) NCT03985800: Specialty Medical Homes to Improve Outcomes for Patients with Inflammatory Bowel Disease (IBD) and Behavioral Health Conditions Trial (PI: ESzigethy)

scholarly journals Advantages and challenges in using telehealth for home-based palliative care: A systematic mixed studies review protocol (Preprint)

2020 ◽  
Author(s):  
Simen A Steindal ◽  
Andréa Aparecida Goncalves Nes ◽  
Tove E. Godskesen ◽  
Susanne Lind ◽  
Alfhild Dhle ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Patient Centered ◽  
Care Services ◽  
Home Based ◽  
Mixed Studies Review ◽  
Palliative Care Services ◽  
Meta Analyses ◽  
Systematic Mixed Studies Review ◽  
At Home

BACKGROUND Due to the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care. OBJECTIVE The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. METHODS This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data and assess methodological quality. The data will then be analyzed using thematic synthesis. RESULTS We described the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. CONCLUSIONS Following the ethos of patient-centered palliative care, this systematic mixed studies review could contribute recommendations for practice and policy enabling the development of telehealth applications and services that align with patients’ preferences and needs when using telehealth applications and services at home.

scholarly journals A Localized Home-based Health Care Delivery Model for Refugees in Jordan

2018 ◽  
Vol 5 (2) ◽  
pp. 29-36
Author(s):  
Salim Suleiman ◽  
Matthew Nance ◽  
Daniel W O'Neill
Keyword(s):  
Care Delivery ◽  
Good Practice ◽  
Lessons Learned ◽  
Local Health ◽  
Team Members ◽  
Home Based ◽  
Care Delivery Model ◽  
Human Need ◽  
Program Description

Interprofessional teams delivering home-based care hold promise as an effective model for vulnerable populations, but examples of good practice are limited.  This case study presents the initial evaluation of a contextualized application of home-based medical care initiated from the faith community in Jordan toward Syrian and Iraqi refugees with constrained access to resources. Reflexive responses to human need by local churches became the basis for home-based medical outreach. Heavily dependent on volunteers, these church-based teams are selected and trained to meet specific needs, inter-professional partnerships were created through networking, and electronic medical records are deployed to facilitate communication and follow-up. The program’s standards of operation are delineated, and a program description is explained which clarifies volunteer selection, training, faith inspiration, communication, continuity, inter-professional partnerships, and addresses obstacles of care.  Based on subjective collective observations of team members, the advantages of the model in practice are reported, along with lessons learned.  These include dignity promotion, contextualization of health in the home, relationship development, inter-faith communication, inter-professional partnerships created through networking with local health professionals of other faiths, and other NGOs. Limitations of the model, and potential application in other contexts concludes the case study. 

A patient-centered digital cost simulator based on Time-Driven Based-Activity Costing: a proof-of-concept study of knee replacement in two private Portuguese hospitals (Preprint)

2021 ◽  
Author(s):  
Salomé Azevedo ◽  
Francisco von Hafe ◽  
Carolina Ramos ◽  
João Leal ◽  
Ana Rita Londral
Keyword(s):  
Knee Replacement ◽  
Care Delivery ◽  
Unit Cost ◽  
Cost Of Care ◽  
Lessons Learned ◽  
Accurate Information ◽  
Proof Of Concept ◽  
Patient Centered ◽  
Patient Journey ◽  
Concept Study

BACKGROUND The number of knee replacement surgeries in OECD countries will continue rising due to the prevalence of osteoarthritis caused by aging and obesity. It is a cost-effective but expensive procedure. Consequently, decision-makers need accurate information on intervention outcomes and costs to manage the healthcare system efficiently. Literature proposed Time-Driven Based-Activity Costing (TDABC) as a cost measurement model that accounts for care cycle complexity, such as patient diversity and treatment variation. However, few studies show how to apply the TDABC model in a real context, considering the existing hospitals' information systems (IS). OBJECTIVE Our primary goal was to design a patient-centered digital cost simulator for assessing the provider's cost of care delivery that complemented the outcomes analysis in Knee Surgery. The secondary goal was to synthesize the learning experience of implementing the method in two Portuguese private hospitals of the same provider. METHODS The proof-of-concept study was designed based on the TDABC model. As the two hospitals had different care delivery chains for the same procedure, each hospital's study was independent. The unit cost of supplying capacity was calculated using data collected from interviews, literature reviews, and general ledger accounts. Both care delivery chains were defined using information from interviews with hospital staff and mapped using Visual Paradigm©. Time estimations were based on direct observation and data exported from hospitals' IS. The patient-centered digital cost simulator was created using Google Sheets. Through a focus group, the multidisciplinary team evaluated the model feasibility and generalisability. RESULTS A patient-centered digital cost simulator and the data structure that allows collecting the most relevant cost analysis data are presented. The main lessons learned are described through this paper and are based on practical application: (1) the patient journey must drive data collection, organization, and analysis for the TDABC implementation; (2) the implementation of TDABC in healthcare involves the commitment and dedication of the healthcare provider's teams; (3) breaking the activities into operations helps to obtain time estimations and allocate resources in the patient care pathway; (4) the listing of the used resources should follow the financial IS classification. CONCLUSIONS The simulator that was developed is still a proof-of-concept, but it enlightened the healthcare provider of future improvements in the existing IS infrastructure. The TDABC implementation requires that the hospitals' IS collect and interoperate different data sources (clinical, financial, and logistics) along the patient pathway. Therefore, future research should focus on developing effective and efficient interfaces to allow importing process, activity, resources, and time information from the existing IS and calculate the total costs of care per patient. Such data needs to be integrated with health outcomes measures in order to monitor healthcare interventions' value.

scholarly journals Staff Perspectives on Lessons Learned From an Interdisciplinary Memory Care Coordination Program

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 326-327
Author(s):  
Inga Antonsdottir ◽  
Quincy Samus ◽  
Melissa Reuland ◽  
Deirdre Johnston ◽  
Morgan Spliedt ◽  
...  
Keyword(s):  
Care Coordination ◽  
Time Management ◽  
Common Ground ◽  
Care Delivery ◽  
Insurance Coverage ◽  
Lessons Learned ◽  
Assessment Tools ◽  
Home Based ◽  
Memory Care ◽  
At Home

Abstract MIND at Home is a home-based care coordination program for persons living with dementia (PLWD) and their informal care partners (CP). Assessments, care planning and coordination is delivered by trained non-clinical Memory Care Coordinators (MCCs), working together on an interdisciplinary team with nurses and geriatric psychiatrists. We report qualitative results from program staff (two nurses and eight MCCs) who implemented the program in the context of two clinical trials. Care team respondents answered open-ended questions covering 5 domains pertaining to: helpful skillsets; positive and challenging factors aspects of care coordination; barriers to care coordination for clients; and improvements suggestions/resources to strengthen the program. Compassion, finding common ground, listening, organization, and time management were reported as critical skills. Staff enjoyed team collaboration, being in and learning about the community, increasing CP confidence and mastery when caring for a PLWD. Reported challenges included documentation in EHR, accessing/navigating resources, driving long distances, unsafe neighborhoods, ambiguous assessment tools, and working with low engagement clients. Common barriers faced by clients (as reported by staff) were financial struggles/poverty, and lack of insurance coverage for needed services. Staff suggested several improvements: better communication strategies, integration with LTSS services and medical providers, 24-hour program hotline, continuous education for staff, simplified data collection and care delivery tracking process. This presentation on the experience of MIND at Home trained nurses and MCCs provides deep insight on how this and similar care coordination programs might be successfully implemented or strengthened.

The influence of patient engagement on the design and implementation of a clinical trial to improve cancer care delivery.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 223-223
Author(s):  
Sarah Barger ◽  
Sean D Sullivan ◽  
Gary H. Lyman ◽  
Dawn L. Hershman ◽  
Ari Bell-Brown ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Care Delivery ◽  
Patient Reported Outcome ◽  
Study Patient ◽  
Advisory Group ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Implementation Challenges ◽  
Patient Reported ◽  
Study Team

223 Background: We have engaged 10 patient partners in the development and implementation of S1415CD, a five-year pragmatic clinical trial currently in year 3 assessing the effectiveness of a guideline-based colony stimulating factor standing order intervention (NCT02728596). Patient partners serve as part of a 21-person External Stakeholder Advisory Group (ESAG), which also includes providers, payers and guidelines experts. This abstract explores the influence of patient partners on the design, tools and implementation of S1415CD Methods: Patient partners advise the study team on protocol development, patient-facing materials and implementation challenges over four teleconferences each year, annual in-person meetings and targeted email communication. All patient partner input from 2014-2017 was tracked, collected and reviewed for impact on the trial. Results: Input from patient partners led to the refinement of the study’s patient-reported outcome (PRO) survey questions, the creation of a highly utilized patient brochure, and the formation of talking points for clinic staff to help explain the study. Patient partners in conjunction with high performing sites helped develop strategies for sites with lower patient accrual to optimize the approach and consent of study participants. Conclusions: The sustained engagement of patient partners in S1415CD ensured patient-centeredness in trial design and guided the development of PRO surveys and relevant, high quality patient-facing materials. Drawing on experiential knowledge and insights from their roles as caregivers and advocates, patient partners provided valuable feedback that influenced patient approach and engagement in the study. Embedding patient partners in the research continuum has catalyzed critical discussions and problem solving among the patient partners and study team, which has led to patient-centered solutions to study challenges. Clinical trial information: NCT02728596.

Updates to the ASCO Patient-Centered Oncology Payment Model

2020 ◽  
Vol 16 (5) ◽  
pp. 263-269 ◽  
Author(s):  
Jeffrey C. Ward ◽  
Brian Bourbeau ◽  
Alexander L. Chin ◽  
Ray D. Page ◽  
Stephen S. Grubbs ◽  
...  
Keyword(s):  
Medical Home ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Quality Measurement ◽  
Lessons Learned ◽  
Multiple Sources ◽  
Patient Centered ◽  
Delivery Of Care ◽  
The Past ◽  
Oncology Care

The past decade has seen considerable innovation in the delivery of care and payment in oncology. Key initiatives have included the development of oncology medical home care delivery standards, the Medicare Oncology Care Model, and multiple commercial payer initiatives. Looking forward, our next challenge is to reflect on lessons learned from these limited-scale demonstration projects and work toward models that are scalable and sustainable and reflect true collaboration between payers and providers sharing common objectives and methods to advance cancer care delivery. To this end, ASCO continues its work on care delivery standards, quality measurement, and alternative payment models. Over the past year, ASCO has received input from physicians, administrators, payers, and employers to update its Patient-Centered Oncology Payment (PCOP) model. PCOP incorporates current work on provider-payer collaboration, the oncology medical home, and the value of clinical pathways and recognizes the need for common quality measurement, performance methodology, and payment structure across multiple sources of payment. The following represents a summary of the entire model. The model includes chapters on PCOP communities, clinical practice transformation, payment methodology, consolidated payments for oncology care, performance methodology, and implementation considerations. In future work, ASCO will continue its support of the PCOP model, including further development of care delivery standards, quality measures, and technology solutions (eg, CancerLinQ).

Building an oncology community of practice.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 47-47
Author(s):  
Anne Willis ◽  
Deena R. Loeffler ◽  
Mandi Pratt-Chapman
Keyword(s):  
Care Delivery ◽  
Lessons Learned ◽  
Special Interest Groups ◽  
Management Approach ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Patient Centered ◽  
Oncology Patient ◽  
Research Dissemination ◽  
Research Findings

47 Background: Oncology patient-centered outcomes research (PCOR) helps stakeholders, including patients, clinicians and policymakers, make decisions about care; yet, research findings may take years to be put into practice. With the increasing availability of survivorship PCOR, better methods are needed to disseminate and implement findings quickly and effectively. Engaging multiple stakeholders is essential to meet this need, and Communities of Practice (CoP) are effective in increasing collaboration across organizations and stakeholders. Methods: The George Washington University (GW) Cancer Institute created a CoP as a knowledge management approach to break down professional and organizational barriers, support learning for people new to the field and facilitate collaboration within and across organizations. The goal of the CoP is to create stronger links across researchers, healthcare professionals and patients by facilitating the sharing of survivorship information and resources. These linkages will result in enhanced dissemination of evidence-based practices. Results: The CoP is housed within the Generation and Translation of Evidence (GATE) website. The site features user-generated content, including descriptions of research findings and evidence-based interventions to succinctly provide information for a variety of stakeholders to guide decision-making as well as descriptions of best practices and lessons learned to capture practice-based efforts that can drive research. GATE features a question-and-answer bank with evidence-based responses by survivorship experts. The CoP includes Ask the Expert sessions to provide researchers an opportunity to interact with clinicians and patients to guide research dissemination. It also includes Special Interest Groups for researchers to create collaborations and advance research agendas. An e-newsletter highlights new GATE content and opportunities to collaborate. Conclusions: There is a clear need to better disseminate and implement survivorship PCOR evidence to improve cancer care delivery. The GATE website will aid in more rapid implementation of survivorship PCOR evidence into clinical practice and foster collaborative dissemination and implementation efforts.

Value-based mental healthcare: The quality aspect

2016 ◽  
Vol 33 (S1) ◽  
pp. S55-S55
Author(s):  
W. Gaebel
Keyword(s):  
Care Delivery ◽  
Mental Healthcare ◽  
Critical Discussion ◽  
Patient Centered ◽  
Comprehensive Overview ◽  
Societal Values ◽  
Care Delivery Model ◽  
Life Years ◽  
Quality Aspects ◽  
Quality Aspect

IntroductionThe goal of value-based healthcare is to improve the quality of care while also lowering healthcare costs. Values may also include societal or research benefits.ObjectivesTo outline the emergence and quality-related concepts of value-based healthcare.AimsTo give a comprehensive overview and critical discussion of quality aspects of value-based mental healthcare including aspects of personal, societal and scientific values.MethodsReview of quality aspects of value-based mental healthcare.ResultsThe quality aspect of value-based healthcare includes the implementation of patient-centered care and may include the assessment of societal values or values for research purposes. Current concepts focus on the reduction of disability-adjusted life years to measure the achievement of values, but may need to be broadened to include benefits to society as a whole or the progress of knowledge about mental disorders in research. Conceptually, addressing such broader value issues may lead to increased benefits and a better appraisal of the value of mental healthcare.ConclusionsThe trend towards value-based mental healthcare aims at creating an efficient care delivery model, that strongly focuses on achieving favorable patient outcomes and may in the future also include creating societal values. It includes the development and implementation of suitable mental health policies and comprehensive quality assessment, plus a broad conceptualization of the value-term and its assessment in value-based mental healthcare.Disclosure of interestThe author has not supplied his declaration of competing interest.

Home-Based Clinical Videoteleconferencing for PTSD: A Patient Centered Model

2012 ◽  
Author(s):  
Leslie Morland ◽  
Steven Thorp ◽  
Ronald Acierno
Keyword(s):  
Patient Centered ◽  
Home Based

Evaluation of Hemidesmus indicus root as an antacid by In vitro

2016 ◽  
Vol 5 (04) ◽  
pp. 4524
Author(s):  
Abdullah Shaikh Farooque ◽  
Md. Azharuddin Ismail Atar*
Keyword(s):  
Skin Diseases ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Acid Neutralizing Capacity ◽  
Standard Drug ◽  
Hemidesmus Indicus ◽  
Neutralizing Capacity ◽  
Loss Of Appetite ◽  
Powdered Drug

Medicinal plants are being widely used, either as single drug or in combination in health care delivery system. Indian Sarsaparilla, Hemidesmus indicus (Family: Asclepiadaceae) is a commonly known Indian Medicinal Plant, which is widely recognized in traditional systems of Medicine. It contains various phytoconstituents belonging to the category glycosides, flavonoids, tannins, sterols and volatile oils. It has been reported as useful in biliousness, blood diseases, dysentery, diarrhea, respiratory disorders, skin diseases, syphilis, fever, leprosy, leucoderma, leucorrhoea, itching, bronchitis, asthma, eye diseases, epileptic fits in children, kidney and urinary disorders, loss of appetite, burning sensation, dyspepsia, nutritional disorders, ulcer and rheumatism. Several studies are being carried towards its activities like analgesic, anti-inflammatory, antiulcer, hepatoprotective, antioxidant and helicobactericidal properties. In our study we have evaluated antacid activity of sariva (Anantmool) by using In-Vitro method, i.e. ANC (Acid Neutralizing Capacity). This evaluation was done by comparing the ANC of sariva macerated & powdered drug with water as blank & standard drug i.e. NaHCO3. Based on this In-Vitro experiment, we can conclude that, the macerated & powdered drug of sariva (Anantmool) evaluated in this study, varied in potency as measured in terms of their ANC. These results having ** i.e. P < 0.01 & Passed the normality test. However, the present study being in-vitro, the effects of antacid may vary In-Vitro; individual variations also contribute to the ultimate effectiveness of as antacid.        

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