Launching Telemedicine in a Tertiary Ambulatory Pediatric Orthopaedic Clinic during the COVID-19 Pandemic: A Retrospective Study (Preprint)

2021 ◽  
Author(s):  
Cynthis Wong ◽  
Melissa Bent ◽  
Hanna Omar ◽  
Oussama Abousamra
Keyword(s):  
Patient Satisfaction ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Metropolitan Area ◽  
Chart Review ◽  
Satisfaction Survey ◽  
Pediatric Orthopaedics ◽  
Time Savings ◽  
Pediatric Orthopaedic ◽  
Comparable Quality

BACKGROUND Telemedicine services increased dramatically during the COVID-19 pandemic, with limited studies on its implementation within pediatric orthopaedics. OBJECTIVE The goal of this study was to examine patient satisfaction and efficacy of telehealth specific to pediatric orthopaedics. METHODS Two hundred and seventy qualifying telehealth visits took place at a metropolitan area pediatric institute between March 1st-May 30th, 2020. Patients were invited to complete an anonymous satisfaction survey on their telehealth experience. Sixty-seven patients responded to the survey. A chart review was completed for all 270 telehealth visits. RESULTS Ninety-two percent (249/270) of telehealth visits were with established patients, and ninety-five percent (256/270) of visits were satisfactorily completed without further evaluation, with one visit requiring urgent in-person evaluation. Overall, patients were satisfied with initiating the telehealth visit (mean score of 4.56/5), as they felt comfortable discussing needs with the provider (4.68/5), and the visit saved time (4.61/5). However, patients were less enthused when deciding if telemedicine was of comparable quality to an in-person visit (3.68/5). CONCLUSIONS Our analysis showed that telehealth is a viable alternative to in-person visits for various pediatric orthopaedic visits, with minimal urgent complications. Patients benefited primarily from the time savings when using a telehealth visit. However, our study also demonstrates certain limitations of telemedicine, likely due to patients’ perceived value of an in-person evaluation. Our study's findings should encourage the continued implementation of pediatric orthopaedic telemedicine as an adjunct to in-person clinical practice.

EXPRESS: The Role of Patient Satisfaction in Hospitals’ Medicare Reimbursements

2020 ◽  
pp. 074391562098472
Author(s):  
Lu Liu ◽  
Dinesh K. Gauri ◽  
Rupinder P. Jindal
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Hospital Care ◽  
Pay For Performance ◽  
Data Sources ◽  
Satisfaction Survey ◽  
The Us ◽  
Performance System ◽  
Diverse Data

Medicare uses a pay-for-performance program to reimburse hospitals. One of the key input measures in the performance formula is patient satisfaction with their hospital care. Physicians and hospitals, however, have raised concerns especially about questions related to patient satisfaction with pain management during hospitalization. They report feeling pressured to prescribe opioids to alleviate pain and boost satisfaction survey scores for higher reimbursements. This over-prescription of opioids has been cited as a cause of current opioid crisis in the US. Due to these concerns, Medicare stopped using pain management questions as inputs in its payment formula. We collected multi-year data from six diverse data sources, employed propensity score matching to obtain comparable groups, and estimated difference-in-difference models to show that, in fact, pain management was the only measure to improve in response to pay-for-performance system. No other input measure showed significant improvement. Thus, removing pain management from the formula may weaken the effectiveness of HVBP program at improving patient satisfaction, which is one of the key goals of the program. We suggest two divergent paths for Medicare to make the program more effective.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

scholarly journals Insulin doses requirements in patients with type 1 diabetes using glargine U300 or degludec in routine clinical practice

2021 ◽  
pp. jim-2020-001633
Author(s):  
Florentino Carral San Laureano ◽  
Mariana Tomé Fernández-Ladreda ◽  
Ana Isabel Jiménez Millán ◽  
Concepción García Calzado ◽  
María del Carmen Ayala Ortega
Keyword(s):  
Type 1 Diabetes ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Real World ◽  
Glycosylated Hemoglobin ◽  
Routine Clinical Practice ◽  
Insulin Analogs ◽  
Total P ◽  
Real Clinical Practice

There are not many real-world studies evaluating daily insulin doses requirements (DIDR) in patients with type 1 diabetes (T1D) using second-generation basal insulin analogs, and such comparison is necessary. The aim of this study was to compare DIDR in individuals with T1D using glargine 300 UI/mL (IGlar-300) or degludec (IDeg) in real clinical practice. An observational, retrospective study was designed in 412 patients with T1D (males: 52%; median age 37.0±13.4 years, diabetes duration: 18.7±12.3 years) using IDeg and IGla-300 ≥6 months to compare DIDR between groups. Patients using IGla-300 (n=187) were more frequently males (59% vs 45.8%; p=0.004) and had lower glycosylated hemoglobin (HbA1c) (7.6±1.2 vs 8.1%±1.5%; p<0.001) than patients using IDeg (n=225). Total (0.77±0.36 unit/kg/day), basal (0.43±0.20 unit/kg/day) and prandial (0.33±0.23 unit/kg/day) DIDR were similar in IGla-300 and IDeg groups. Patients with HbA1c ≤7% (n=113) used significantly lower basal (p=0.045) and total (p=0.024) DIDR, but not prandial insulin (p=0.241), than patients with HbA1c between 7.1% and 8% and >8%. Patients using IGla-300 and IDeg used similar basal, prandial and total DIDR regardless of metabolic control subgroup. No difference in basal, prandial and total DIDR was observed between patients with T1D using IGla-300 or IDeg during at least 6 months in routine clinical practice.

scholarly journals Interobserver Reliability of Pirani and Dimeglio Scores in the Clinical Evaluation of Idiopathic Congenital Clubfoot

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 618
Author(s):  
Vito Pavone ◽  
Andrea Vescio ◽  
Annalisa Culmone ◽  
Alessia Caldaci ◽  
Piermario La Rosa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Evaluation ◽  
Interobserver Reliability ◽  
Strongly Correlated ◽  
Congenital Talipes Equinovarus ◽  
Orthopaedic Surgeons ◽  
Careful Preparation ◽  
Talipes Equinovarus ◽  
Pediatric Orthopaedic ◽  
Paediatric Orthopaedic

Background: Dimeglio (DimS) and Pirani (PirS) scores are the most common scores used in congenital talipes equinovarus (CTEV) clinical practice. The aim of this study was to evaluate the interobserver reliability of these scores and how clinical practice can influence the clinical outcome of clubfoot through the DimS and Pirs. Methods: Fifty-four feet were assessed by six trained independent observers through the DimS and PirS: three consultants (OS), and three residents (RS) divided into three pediatric orthopaedic surgeons (PeO) and three non-pediatric orthopaedic surgeons (NPeO). Results: The PirS and DimS Scores were strongly correlated. In the same way, OS and RS, PirS, and DimS scores were strongly correlated, and the interobserver reliability ranked “good” in the comparison between PeO and NPeO. In fully trained paediatric orthopaedic surgeons, an “excellent” interobserver reliability was found but was only “good” in the NPeO cohort. Conclusions: In conclusion, after careful preparation, at least six months of observation of children with CTEV, PirS and DimS proved to be valid in terms of clinical evaluation. However, more experience with CTEV leads to a better clinical evaluation.

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