A RAND-Modified Delphi on Key Indicators to Measure the Efficiency of Living Kidney Donor Candidate Evaluations

Background and objectivesMany patients, providers, and potential living donors perceive the living kidney donor evaluation process to be lengthy and difficult to navigate.Design, setting, participants, & measurementsWe sought consensus on key terms and process and outcome indicators that can be used to measure how efficiently a transplant center evaluates persons interested in becoming a living kidney donor. Using a RAND-modified Delphi method, 77 participants (kidney transplant recipients or recipient candidates, living kidney donors or donor candidates, health care providers, and health care administrators) completed an online survey to define the terms and indicators. The definitions were then further refined during an in-person meeting with ten stakeholders.ResultsWe identified 16 process indicators (e.g., average time to evaluate a donor candidate), eight outcome indicators (e.g., annual number of preemptive living kidney donor transplants), and two measures that can be considered both process and outcome indicators (e.g., average number of times a candidate visited the transplant center for the evaluation). Transplant centers wishing to implement this set of indicators will require 22 unique data elements, all of which are either readily available or easily collected prospectively.ConclusionsWe identified a set of indicators through a consensus-based approach that may be used to monitor and improve the performance of a transplant center in how efficiently it evaluates persons interested in becoming a living kidney donor.

Download Full-text

Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

Canadian Journal of Dietetic Practice and Research ◽

10.3148/67.0.2006.s14 ◽

2006 ◽

Vol 67 (S1) ◽

pp. S14-S29 ◽

Cited By ~ 12

Author(s):

Paula Brauer ◽

Linda Dietrich ◽

Bridget Davidson ◽

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Administrative Support ◽

Care Service ◽

Delphi Process ◽

Care Providers ◽

Modified Delphi ◽

Nutrition Services ◽

Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

Download Full-text

Identifying and Prioritizing Gaps in Neuroendocrine Tumor Research: A Modified Delphi Process With Patients and Health Care Providers to Set the Research Action Plan for the Newly Formed Commonwealth Neuroendocrine Tumor Collaboration

Journal of Global Oncology ◽

10.1200/jgo.2016.006916 ◽

2017 ◽

Vol 3 (4) ◽

pp. 380-388 ◽

Cited By ~ 3

Author(s):

Eva Segelov ◽

David Chan ◽

Ben Lawrence ◽

Nick Pavlakis ◽

Hagen F. Kennecke ◽

...

Keyword(s):

Health Care ◽

Neuroendocrine Tumor ◽

Health Care Providers ◽

Action Plan ◽

Research Priorities ◽

Delphi Process ◽

Care Providers ◽

Curative Surgery ◽

Modified Delphi ◽

Research Action

Purpose Neuroendocrine tumors (NETs) are a diverse group of malignancies that pose challenges common to all rare tumors. The Commonwealth Neuroendocrine Tumor Collaboration (CommNETS) was established in 2015 to enhance outcomes for patients with NETs in Canada, Australia, and New Zealand. A modified Delphi process was undertaken involving patients, clinicians, and researchers to identify gaps in NETs research to produce a comprehensive and defensible research action plan. Methods A three-round modified Delphi process was undertaken with larger representation than usual for medical consensus processes. Patient/advocate and health care provider/researcher expert panels undertook Round 1, which canvassed 17 research priorities and 42 potential topics; in Round 2, these priorities were ranked. Round 3 comprised a face-to-face meeting to generate final consensus rankings and formulate the research action plan. Results The Delphi groups consisted of 203 participants in Round 1 (64% health care providers/researchers, 36% patient/advocates; 52% Canadian, 32% Australian, and 17% New Zealander), of whom 132 participated in Round 2. The top eight priorities were biomarker development; peptide receptor radionuclide therapy optimization; trials of new agents in advanced NETs; functional imaging; sequencing therapies for metastatic NETs, including development of validated surrogate end points for studies; pathologic classification; early diagnosis; interventional therapeutics; and curative surgery. Two major areas were ranked significantly higher by patients/advocates: early diagnosis and curative surgery. Six CommNETS working parties were established. Conclusion This modified Delphi process resulted in a well-founded set of research priorities for the newly formed CommNETS collaboration by involving a large, diverse group of stakeholders. This approach to setting a research agenda for a new collaborative group should be adopted to ensure that research plans reflect unmet needs and priorities in the field.

Download Full-text

Development of a framework for increasing asthma awareness in Chitungwiza, Zimbabwe

Asthma Research and Practice ◽

10.1186/s40733-019-0052-2 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Pisirai Ndarukwa ◽

Moses J. Chimbari ◽

Elopy N. Sibanda

Keyword(s):

Health Care ◽

Public Relations ◽

Health Care Providers ◽

Health Professionals ◽

Care Providers ◽

The Public ◽

Modified Delphi ◽

Lack Of Information ◽

Care Costs

Abstract Background Asthma accounts for significant global morbidity and health-care costs. It is still poorly understood among health professionals and the general population. Consequently, there are significant morbidity and mortality rates throughout the globe. The aim of this study was to develop a framework to increase asthma awareness at Chitungwiza Hospital, Zimbabwe. Methods A modified Delphi model was used to collect data to develop a framework for increasing asthma awareness. At baseline (round 1) in-depth interviews with 44 medical doctors were carried out to understand the level of asthma awareness. Round 2 data collection was in the form of a workshop involving a total of 15 doctors, 30 nurses, four public relations officers, and two health education and promotion officers. The same participants who were engaged in round 2 were also involved in the third round where consensus was achieved by the health professionals. Results Our study showed that awareness to asthma among health care providers was affected by mimicry of symptoms and lack of continuous education on asthma. Our study showed lack of Information Education and Communication (IEC) material and lack of use of bulk messages affected asthma awareness. Our study showed that clinical meetings on asthma, having asthma training manuals, (IEC) materials and guidelines for asthma diagnosis and management could improve health care providers’ awareness of asthma. Bulk messages on asthma through network providers, social media and bill boards, commemorating world asthma day, edutainment, asthma ambassadors and multimedia were suggested as means of improving awareness of asthma among the public. Conclusion We concluded that awareness of asthma can be improved using a framework. Such a framework ultimately improves the quality of asthma care.

Download Full-text

44 It’s All About That Trach! Using a Modified Delphi Approach to Developing Pediatric Tracheostomy Teaching Tools

Paediatrics & Child Health ◽

10.1093/pch/pxab061.035 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e32-e32

Author(s):

Prachi Shah ◽

Tamizan Kherani ◽

Elizabeth (Anne) Hicks

Keyword(s):

Health Care ◽

Home Care ◽

Health Care Providers ◽

Health Care Professionals ◽

Care Home ◽

Video Adaptation ◽

Care Providers ◽

Teaching Materials ◽

Modified Delphi ◽

Delphi Approach

Abstract Primary Subject area Medical Education Background Pediatric tracheostomy care is intimidating; regular and emergency care are critical skills. Tracheostomy care training is vital for pediatric patients who have multiple people involved in their care and are fully dependent on their tracheostomy tubes for breathing. An Alberta team is developing an informational tool, the “Tracheostomy Journey”, to help families and health care providers understand and communicate clearly about pediatric tracheostomy. A needs assessment identified consistent, universal, multimodal teaching and communication tools for families, trainees, and hospital and home care providers as a primary need. Consistency in training will also improve communication between caregivers and families. Objectives The main objective of this study was to develop shareable pediatric tracheostomy care and management teaching materials for health care professionals and families. The goals of such information are to ensure checks and balances, provide universal, consistent and cohesive teaching content to all caregivers, set expectations, and promote effective communication. Design/Methods A modified Delphi approach provided structured development of training modules using existing diverse teaching materials. Participants were asked to focus on safe, consistent pediatric tracheostomy care. Two components were to: 1) Update and consolidate basic hospital discharge checklists for families; 2) Formalize current unstructured emergency training while building new resources to teach families, staff, and trainees through goal-oriented simulations. Results We consolidated 7 Home Care tracheostomy care checklists and developed 24 simulations to teach specific care skills, incorporating input from multiple stakeholders to consolidate and unify content. Participants included primary care and subspecialty physicians (Respirology, Otolaryngology, Pediatric and Neonatal Intensive Care), home care, nursing, respiratory therapy, trainees, and families. The teaching materials emphasize inclusive, acceptable skill and confidence-building as well as mastery. Each module includes a scenario, preceptor script, and debriefing materials. Scripting is designed for future video adaptation, to allow review. Pilot evaluation with trainees included knowledge and confidence assessment before and after training, after training specifically addressed the question: “Do they address the goal?”. Conclusion Training materials were developed by an expert team via a modified Delphi process and met the intended goals of being accessible, acceptable, inclusive, and effective at teaching and consolidating the skills of those involved in pediatric tracheostomy care. These tools are ready to employ and are anticipated to improve teaching and communication for families and trainees caring for children with tracheostomy.

Download Full-text

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500012973 ◽

1999 ◽

Vol 27 (2) ◽

pp. 203-203

Author(s):

Kendra Carlson

Keyword(s):

Health Care ◽

Supreme Court ◽

Health Care Providers ◽

Elder Abuse ◽

Skilled Nursing Facility ◽

Pressure Sores ◽

Care Providers ◽

Nursing Facility ◽

Skilled Nursing ◽

The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Download Full-text

Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations ◽

10.1044/cds19.3.71 ◽

2012 ◽

Vol 19 (3) ◽

pp. 71-76 ◽

Cited By ~ 1

Author(s):

Pauline A. Mashima

Keyword(s):

Health Care ◽

Health Care Providers ◽

Access To Health Care ◽

Underserved Populations ◽

Linguistically Diverse ◽

Care Providers ◽

Department Of Health ◽

Use Of Technology ◽

Access To Health ◽

Improve Access

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

Download Full-text

Interdisciplinary Therapy Assessments for the Older Adult

Perspectives on Gerontology ◽

10.1044/gero17.1.11 ◽

2012 ◽

Vol 17 (1) ◽

pp. 11-16

Author(s):

Lynn Chatfield ◽

Sandra Christos ◽

Michael McGregor

Keyword(s):

Older Adults ◽

Health Care ◽

Standardized Testing ◽

Health Care Providers ◽

Outcome Measurement ◽

Care Providers ◽

Patient Centered ◽

Screening Process ◽

Evidenced Based ◽

Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

Download Full-text