The Computer Will See You Now: A Scoping Review of Digital Tools Designed to Obtain the History of Present Illness from Patients (Preprint)

2021 ◽  
Author(s):  
Carl Thomas Berdahl ◽  
Andrew J Henreid ◽  
Joshua M Pevnick ◽  
Kai Zheng ◽  
Teryl K Nuckols
Keyword(s):  
Quality Of Care ◽  
Outcome Measures ◽  
Digital Library ◽  
Scoping Review ◽  
Digital Tools ◽  
Supplementary Information ◽  
Inclusion Criteria ◽  
Face To Face ◽  
History Of

BACKGROUND Many medical conditions—perhaps 80% of them—can be diagnosed by taking a thorough history of present illness (HPI). In the clinical setting, however, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and/or fragmented. One solution for improving clinicians’ ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI prior to face-to-face evaluation by a clinician. OBJECTIVE Our objective was to identify and characterize digital tools that have been designed to (1) obtain the history of present illness (HPI) directly from patients or caregivers and (2) present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care. METHODS We conducted a scoping review using pre-defined search terms in the following databases: MEDLINE, CINAHL, PsychInfo, Web of Science, Embase, IEEE Digital Library, ACM Digital Library, and ProQuest Dissertations. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting inclusion criteria, and used a pile sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; supplementary information was also obtained from tool websites and through direct communications with tool creators. RESULTS We identified 18 tools meeting inclusion criteria. Among them, 14 tools used primarily close-ended and/or multi-choice questions, 1 tool used free-text input, and 3 used conversational (chatbot) style. In total, 10 tools were tailored to specific patient subpopulations, and 8 did not specify a target subpopulation. Seven tools included multilingual support, and 12 had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and/or quality of care. CONCLUSIONS The 18 HPI tools we identified varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes. CLINICALTRIAL N/A

scholarly journals Interprofessional Collaboration on Mental Health: A Scoping Review

2020 ◽  
Author(s):  
Arista Kusuma Wardani ◽  
◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Mental Health Care ◽  
Scoping Review ◽  
Interprofessional Collaboration ◽  
Free Access ◽  
Inclusion Criteria

ABSTRACT Background: The increasing prevalence rate of mental illness due to demographic changes became the burden of disease in primary health care. Effective interprofessional collaboration strategies are required to improve professional welfare and quality of care. Interdisciplinary teamwork plays an important role in the treatment of chronic care, including mental illness. This scoping review aimed to investigate the benefit and barrier of interprofessional collaboration approach to mental health care. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selection; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The search included PubMed, Science­Direct, and Willey Online library databases. The inclusion criteria were English-language, full-text, and free access articles published between 2010 and 2020. The data were reported by the PRISMA flow chart. Results: A total of 316 articles obtained from the search databases, in which 263 articles unmet the inclusion criteria and 53 duplicates were excluded. Based on the selected seven articles, one article from a developed country (Malaysia), and six articles from developing countries (Australia, Canada, Belgium, Norway) with quantitative (cross-sectional, surveil­lance) and qualitative study designs. The reviewed findings were benefit and barrier of interprofessional collaboration on mental health. Benefits included improve quality of care, increase job satisfaction, improve patient health status, increase staff satisfaction, increase performance motivation among employees, as well as shorter duration of treat­ment and lower cost. Barriers included hierarchy culture, lack of resources, lack of time, poor communication, and inadequate training. Conclusion: Interprofessional teamwork and collaboration have been considered an essential solution for effective mental health care. Keywords: interprofessional collaboration, benefit, barrier, mental health Correspondence: Arista Kusuma Wardani. Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi (Ring Road Barat) No. 63 Mlangi, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: wardanikusuma­[email protected]. Mobile: +6281805204773 DOI: https://doi.org/10.26911/the7thicph.04.26

scholarly journals Ordinal outcome analysis improves the detection of between-hospital differences in outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. E. Ceyisakar ◽  
N. van Leeuwen ◽  
Diederik W. J. Dippel ◽  
Ewout W. Steyerberg ◽  
H. F. Lingsma
Keyword(s):  
Logistic Regression ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Statistical Power ◽  
Ordinal Scale ◽  
Efficiency Gain ◽  
Number Of Patients ◽  
Dichotomous Outcomes ◽  
Ordinal Outcome

Abstract Background There is a growing interest in assessment of the quality of hospital care, based on outcome measures. Many quality of care comparisons rely on binary outcomes, for example mortality rates. Due to low numbers, the observed differences in outcome are partly subject to chance. We aimed to quantify the gain in efficiency by ordinal instead of binary outcome analyses for hospital comparisons. We analyzed patients with traumatic brain injury (TBI) and stroke as examples. Methods We sampled patients from two trials. We simulated ordinal and dichotomous outcomes based on the modified Rankin Scale (stroke) and Glasgow Outcome Scale (TBI) in scenarios with and without true differences between hospitals in outcome. The potential efficiency gain of ordinal outcomes, analyzed with ordinal logistic regression, compared to dichotomous outcomes, analyzed with binary logistic regression was expressed as the possible reduction in sample size while keeping the same statistical power to detect outliers. Results In the IMPACT study (9578 patients in 265 hospitals, mean number of patients per hospital = 36), the analysis of the ordinal scale rather than the dichotomized scale (‘unfavorable outcome’), allowed for up to 32% less patients in the analysis without a loss of power. In the PRACTISE trial (1657 patients in 12 hospitals, mean number of patients per hospital = 138), ordinal analysis allowed for 13% less patients. Compared to mortality, ordinal outcome analyses allowed for up to 37 to 63% less patients. Conclusions Ordinal analyses provide the statistical power of substantially larger studies which have been analyzed with dichotomization of endpoints. We advise to exploit ordinal outcome measures for hospital comparisons, in order to increase efficiency in quality of care measurements. Trial registration We do not report the results of a health care intervention.

scholarly journals Access to care and worsening eating disorder symptomatology in youth during the COVID-19 pandemic

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Rebecca Spigel ◽  
Jessica A. Lin ◽  
Carly E. Milliren ◽  
Melissa Freizinger ◽  
Julia A. Vitagliano ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Eating Disorder ◽  
Access To Care ◽  
Treatment Quality ◽  
Related Factors ◽  
Web Based ◽  
Face To Face ◽  
Recovery Study ◽  
And Behaviors

Abstract Background Shelter-in-place orders and social distancing guidelines, in response to the COVID-19 pandemic, have limited traditional face-to-face interactions and led to many clinical providers transitioning to the use of videoconferencing platforms. The present study aims to assess how the COVID-19 pandemic has impacted adolescents’/young adults’ (AYA) eating disorder (ED)-related care, and how access to, changes in, perceived disruptions to, and quality of care are associated with ED thoughts and behaviors. Methods AYA enrolled in the RECOVERY study, a pre-existing web-based longitudinal study, and completed a COVID-19-specific survey (n = 89). We examined bivariate associations of four markers of care: i) access to care, ii) changes in care, iii) perceived disruption to care, and iv) quality of care. Using multiple logistic regression, we examined the associations of pandemic-related markers of care with changes in ED thoughts and behaviors. We excluded those not engaged in treatment pre-pandemic (n = 16). Results In the remaining 73 participants, reported access to care was high, with 92% of respondents continuing care with at least one ED provider during the pandemic; however, 47% stopped some treatment during the pandemic. Nearly one-third (32%) perceived a disruption in treatment. Quality of care remained high with 67% reporting care to be better than or as good as pre-pandemic. Respondents acknowledged heightened symptomatology: 81% reported increased ED thoughts and 81% reported increased ED behaviors due to COVID-19-related factors. However, none of the markers of care described were significantly associated with ED thoughts or behaviors in regression analyses adjusting for demographic variables and baseline characteristics, except our quality of care measure which was approaching significance (p = 0.07). Conclusions Our findings show the majority of AYA who had care prior to the pandemic continued receiving some element of their multi-disciplinary ED treatment and perceived their care as high quality. None of the markers of care described were statistically associated with increased ED thoughts and behaviors.

A atuação do enfermeiro auditor na qualidade da assistência à saúde: revisão bibliográfica integrativa

2021 ◽  
Vol 21 (83) ◽  
Author(s):  
Gabriela Marchiori do Carmo Azzolin
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Quality Of Health Care ◽  
Nursing Process ◽  
Inclusion Criteria ◽  
Great Relevance ◽  
Role Of Nursing ◽  
Selection Of

Objetivo: descrever a atuação do enfermeiro auditor na qualidade da assistência a saúde. Método: trata-se de uma revisão integrativa de artigos publicados no período de 2015 a 2020. A pesquisa e seleção dos artigos foi realizada nas bases de dados: BEDENF, LILACS e MEDLINE, por meio dos descritores “Enfermagem”, “Auditoria de enfermagem” , “Registros de enfermagem” e “ Qualidade da assistência à saúde”. Os critérios de inclusão foram artigos online gratuitos, com textos completos, publicados de 2015 a 2020, nos idiomas português e inglês. Resultados: foram selecionados 11 artigos, por cumprirem os critérios estabelecidos no estudo. Na análise dos resultados foi possível evidenciar a importância significativa da qualidade dos registros no processo de enfermagem. Conclusão: a atuação da enfermagem na auditoria tem ganhado notoriedade nos últimos anos, por ser de grande relevância para a qualidade da assistência prestada e abranger muito mais que a gestão de custos.Palavras-chave: Enfermagem; Auditoria de enfermagem; Registros de enfermagem; Qualidade da assistência à saúde. The auditor's nurse's performance in the quality of health care: integrative bibliographic review ABSTRACTObjective: to describe the role of the nurse auditor in the quality of health care. Method: this is an integrative review of articles published from 2015 to 2020. The research and selection of articles was carried out in the databases: BEDENF, LILACS and MEDLINE, using the descriptors “Nursing”, “Nursing audit "," Nursing records "and" Quality of health care ". The inclusion criteria were free online articles, with full texts, published from 2015 to 2020, in Portuguese and English. Result: 11 articles were selected, as they meet the criteria established in the study. In the analysis of the results, it was possible to highlight the significant importance of the quality of the records in the nursing process. Conclusio: the role of nursing in the audit has gained notoriety in recent years, as it is of great relevance to the quality of care provided and covers much more than cost management.Keywords: Nursing; Nursing audit; Nursing records; Quality of health care.

Effects of Physician-Patient Electronic Communications on the Quality of Care

2013 ◽  
Vol 2 (2) ◽  
pp. 54-62 ◽  
Author(s):  
Shima Tabatabai
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Electronic Communication ◽  
Process Efficiency ◽  
Electronic Communications ◽  
Face To Face ◽  
Potential Benefits ◽  
Healthcare Process ◽  
Physician Patient

The article summarizes evidence about the effectiveness of patient–physician electronic communication. The emphasis was on the importance of understanding the potential impact of e-communication on patient satisfaction, and on the quality of health care. A review of literature was performed in the area of patient–physician electronic communication, and references were appraised, and synthesized for an overview of benefits and challenges of this model of communication. Electronic communication is becoming popular, has the potential to transform the health care system, and support the patient–physician interaction. Patients are enthusiastic about this convenience model of communication, and feel strongly embraced in communicating via email & web messaging. Although, there is evidence that electronic communication could increase quality of care due to increased interaction and would extend health care efficiency, a variety of potential benefits and challenges is reported. Overall, electronic communication introduces a new model of patient-physician interaction that could supplement and reasonably replace a portion of traditional face-to-face encounters. However, further investigation is required to assess its impact on healthcare process efficiency.

scholarly journals Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Monica Ansu-Mensah ◽  
Frederick I. Danquah ◽  
Vitalis Bawontuo ◽  
Peter Ansu-Mensah ◽  
Desmond Kuupiel
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Scoping Review ◽  
Maternal Care ◽  
Service Utilisation ◽  
Care Policy ◽  
Maternal Healthcare ◽  
Maternal Perceptions ◽  
Free Care

Abstract Background The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA. Methods We employed the Arskey and O’Malley’s framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies. Results Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system. Conclusion This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.

PP30 ‘I can’t remember’ – patients views of receiving pain management from paramedics for suspected hip fracture

2019 ◽  
Vol 36 (1) ◽  
pp. e12.1-e12
Author(s):  
Bridie Evans ◽  
Alan Brown ◽  
Jenna Bulger ◽  
Greg Fegan ◽  
Simon Ford ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Hip Fracture ◽  
Pain Management ◽  
Prehospital Care ◽  
Face To Face ◽  
Experience Of Care ◽  
Ambulance Transport ◽  
Fascia Iliaca Compartment Block ◽  
To Receive

BackgroundUp to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture.ObjectiveTo explore patients’ views and experience of care received for suspected hip fracture and in particular FICB before ambulance transport to hospital.MethodWe interviewed six patients and the daughter of a patient who received FICB to manage their suspected hip fracture. Interviews, by telephone or face-to-face, were audio-recorded with consent. We conducted thematic analysis of transcripts. Two researchers, one paramedic and one lay member were in the analysis teamResultsRespondents’ memory of prehospital care was dominated by their experience of extreme pain. While they recalled events before falling, they only had partial memory of care prior to hip surgery. Although they recalled paramedics’ arrival, which they reported was up to six hours after their injury, respondents said they remembered little else. Just one recalled consenting to receiving FICB and could describe the process. Other respondents said they were in too much pain to comprehend what occurred or respond coherently. They explained their priority was to receive pain management and they expected the paramedics to treat them safely and effectively. Respondents appeared to be a stoical and trusting group who accepted the treatment they were offered. They did recall high quality of care and praised paramedics for their reassuring and calm manner.ConclusionsHip fracture patients’ overwhelming memory of injury and treatment was of pain and their priority was to receive pain relief. The quality of care, reassurance and administration of pain management was more important to patients than the mechanism of delivering the intervention.

scholarly journals Systematic review of the psychometric properties of patient-reported outcome measures for rheumatoid arthritis in the foot and ankle

2019 ◽  
Vol 33 (11) ◽  
pp. 1788-1799 ◽  
Author(s):  
Ana Belen Ortega-Avila ◽  
Laura Ramos-Petersen ◽  
Pablo Cervera-Garvi ◽  
Christopher J Nester ◽  
José Miguel Morales-Asencio ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Psychometric Properties ◽  
Outcome Measures ◽  
Methodological Quality ◽  
Measurement Properties ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
Patient Reported

Objective: To identify self-reported outcome measures specific to the foot and ankle in patients with rheumatoid arthritis and to investigate the methodological quality and psychometric properties of these measures. Method: A systematic review focusing on patients with rheumatoid arthritis. Setting: The search was conducted in the PubMed, SCOPUS, CINAHL, PEDro and Google Scholar databases, based on the following inclusion criteria: population (with rheumatoid arthritis) > 18 years; psychometric or clinimetric validation studies of patient-reported outcomes specific to the foot and ankle, in different languages, with no time limit. Two of the present authors independently assessed the quality of the studies located and extracted the relevant data. Terwee’s criteria and the COSMIN checklist were employed to ensure adequate methodological quality. Results: Of the initial 431 studies considered, 14 met the inclusion criteria, representing 7,793 patients (56.8 years). These instruments were grouped into three dimensions (pain, perceived health status and quality of life and disability). The time to complete any of the PROMs varies around 15 minutes. PROMs criterias with the worst scores by COSMIN, 92.85% and 85.71% were criterion validity, measurement error, internal consistency and responsiveness. 28.57% of PROMs were compared with the measurement properties. Conclusion: the Self-Reported Foot and Ankle Score achieved the highest number of positive criteria (according to Terwee and COSMIN), and is currently the most appropriate for patients with Rheumatoid arthritis.

scholarly journals Four Needles in a Haystack: A Systematic Review Assessing Quality of Health Care in Specialty Practice by Practice Type

2018 ◽  
Vol 55 ◽  
pp. 004695801878704
Author(s):  
Shellie D. Ellis ◽  
Saleema A. Karim ◽  
Rachel R. Vukas ◽  
Daniel Marx ◽  
Jalal Uddin
Keyword(s):  
Quality Of Care ◽  
Organizational Factors ◽  
The United States ◽  
Group Practice ◽  
Inclusion Criteria ◽  
Group Practices ◽  
Specialty Practice ◽  
Multidisciplinary Group ◽  
The Impact

Specialists, who represent 60% of physicians in the United States, are consolidating into large group practices, but the degree to which group practice type facilitates the delivery of high quality of care in specialty settings is unknown. We conducted a systematic literature review to identify the impact of group practice type on the quality of care among specialty providers. The search resulted in 913 articles, of which only 4 met inclusion criteria. Studies were of moderate methodological quality. From the limited evidence available, we hypothesize that solo specialists deliver care that is inferior to their peers in group practice, whether measured by patient satisfaction ratings or adherence to guideline-based care. However, solo specialists and multidisciplinary group specialists may be more likely to provide some specialized services compared with their single-specialty group peers. Insufficient research compares quality of care among different practice types in specialty care. Substantial opportunity exists to test the degree to which organizational factors, whether size of practice or the mix of providers within the practice, influence quality of care in specialty settings.

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