scholarly journals From outcome measurement to improving health outcomes following lower limb amputation - making outcome measurement work from a clinical practice perspective

2020 ◽  
Author(s):  
Chantel Ostler ◽  
Helen Scott ◽  
Imad Sedki ◽  
Sisary Kheng ◽  
Maggie Donovan-Hall ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Lower Limb ◽  
Care Delivery ◽  
Outcome Measurement ◽  
Narrative Review ◽  
Successful Outcome ◽  
Prosthetic Rehabilitation ◽  
Clinical Narrative ◽  
The Impact

Background: Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional encouragement outcome measurement has failed to become embedded in clinical practice and its value continues to be questioned. Objectives: To address the outcome measurement debate within lower limb prosthetic rehabilitation and provide a critical synthesis of the evidence surrounding the discussion applied within the clinical context of the UK National Health Service (NHS).Study Design: Narrative review Methods: The authors drew on over 20 years clinical experience in prosthetic rehabilitation to synthesise and critique the outcome literature across a breadth of healthcare services. A narrative review methodology was selected to give voice to the clinical narrative thread.Results: This review addresses why we should measure health outcomes, the health care delivery and organisational scenarios in which outcome measurement can be beneficial and explores where lessons can be learnt for prosthetic rehabilitation from approaches in different specialities. The current outcome measurement literature within prosthetic rehabilitation is critiqued and we discuss the issues facing this field in the future.Conclusions: The dilemma of successful outcome measurement in clinical practice is multifaceted. Understanding and embedding value at every step is key to success. Addressing the questions of `why’, `what’ and `how’ we measure outcome will move us closer to a national consensus. Routine outcome measurement implementation at the clinical level must ensure data collection is valuable to clinical practice, makes use of IT solutions and has all important organisational buy in.

scholarly journals Disabling stroke in persons already with a disability

Neurology ◽  
2020 ◽  
Vol 94 (7) ◽  
pp. 306-310 ◽  
Author(s):  
Michael J. Young ◽  
Robert W. Regenhardt ◽  
Thabele M. Leslie-Mazwi ◽  
Michael Ashley Stein
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Clinical Practices ◽  
Acute Stroke Care ◽  
Persons With Disabilities ◽  
Stroke Research ◽  
Scant Attention

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

Harnessing AI for health equity in oncology research and practice.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 67-67
Author(s):  
Alexandra Urman ◽  
Ching-Kun Wang ◽  
Irene Dankwa-Mullan ◽  
Ethan Scheinberg ◽  
Michael J. Young
Keyword(s):  
Clinical Practice ◽  
Health Equity ◽  
Cancer Susceptibility ◽  
Care Delivery ◽  
Diagnostic Errors ◽  
Ethical Challenges ◽  
Ethical Implications ◽  
Oncology Research ◽  
Oncology Care ◽  
The Impact

67 Background: Recent advances in artificial intelligence (AI) carry underexplored practical and ethical implications for the practice of clinical oncology. As oncologic applications of AI proliferate, a framework for guiding their ethical implementations and equitable distribution will be crucial. Methods: We reviewed the current landscape of AI applications in oncology research and clinical practice by reviewing the current body of evidence in PubMed and Medline. Key ethical challenges and opportunities to address health equity are critically evaluated and highlighted. Ethical implications for patients, clinicians and society at large are delineated, with particular focus on the impact and ramifications of AI with respect to healthcare disparities and equity of oncology care delivery. Results: Growing concerns that AI may widen disparities in oncologic care by virtue of lack of affordability, inconsistent accessibility and biased machine-learning models are addressed. Although there is potential for AI to widen disparities in oncology care, using foresight in application, AI has the potential to (1) democratize access to specialized clinical knowledge, (2) improve the accuracy of predicting cancer susceptibility, recurrence and mortality, (3) prevent diagnostic errors in under-resourced settings, (4) minimize unintended bias and (5) enable access to tailored therapeutic options including clinical trials if appropriately deployed. Separately, AI can be harnessed to identify areas of underserved needs and optimize systems of health-information sharing and reimbursements as blockchain technology converges with AI. As AI advances it will have a larger presence in oncology research and clinical practice. Conclusions: A strategic framework integrating ethical standards and emphasizing equitable implementation can help ensure that the potential of AI to address disparities in oncology are maximally captured and its perils averted. Further work is being done on exploring these challenges and will be submitted as a manuscript.

scholarly journals Development of a Rural Family Practice Rotation in an Athletic Training Residency Program

2017 ◽  
Vol 12 (3) ◽  
pp. 188-194
Author(s):  
Forrest Q. Pecha ◽  
Lucas A. Bahnmaier ◽  
Jefferson J. Wetherington ◽  
Alejandro A. Homaechevarria ◽  
Jon Schott
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Athletic Training ◽  
Family Practice ◽  
Health Care Delivery ◽  
Interprofessional Collaboration ◽  
Care Delivery ◽  
Athletic Training Education ◽  
Rural Family ◽  
The Impact

Context: Postprofessional residency (PPR) programs continue to gain popularity as athletic training education prepares for a paradigm shift. The Commission on Accreditation of Athletic Training Education has established didactic and clinical infrastructure for PPRs seeking accreditation. Accredited programs provide athletic trainers (ATs) with an advanced level of knowledge in a focused area of clinical practice. Objective: A case study report to introduce a novel PPR general medical rotation to illustrate the skills and knowledge of ATs, evaluate the impact of the athletic training residents in the rural family practice (FP) setting, and to discuss how employing an AT in this setting aligns with the triple aim of the Affordable Care Act (ACA). Background: Currently, there is very little literature regarding PPRs. Additionally, very little research exists describing how ATs function within the ACA model of health care delivery. Description: The PPR developed a rotation for a rural FP outpatient clinic. Athletic training residents completed 3-week rotations in this setting working with multiple providers. Learning objectives were created to emphasize the evaluation, diagnosis, and management of general medical conditions. Objectives were assessed at the conclusion of the rotation. Finally, data were collected to evaluate the impact of athletic training residents in the ACA model of health care delivery. Clinical Advantage(s): The athletic training residents improved their clinical evaluation and diagnosis skills in a FP clinic through this educational opportunity. This rotation cultivated and fostered interdisciplinary education and interprofessional collaboration. Finally, the observational findings of this rotation revealed the impact of ATs appear to align with the objectives of the ACA health care model, supporting the use of ATs in this role. Conclusion(s): This rotation highlights an area of clinical practice future ATs could pursue. Accredited PPR programs must consider the evolution in health care delivery and the shift in athletic training education standards to develop strong PP programs.

The DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure: What do we know about it now?

2001 ◽  
Vol 6 (4) ◽  
pp. 109-118 ◽  
Author(s):  
Dorcas E Beaton ◽  
Aileen M Davis ◽  
Pamela Hudak ◽  
Sara Mcconnell
Keyword(s):  
Clinical Practice ◽  
Physical Function ◽  
Outcome Measures ◽  
Musculoskeletal System ◽  
Outcome Measure ◽  
Outcome Measurement ◽  
Future Research ◽  
Strength Testing ◽  
Joint Motion ◽  
The Impact

Outcome measurement is an essential component for defining the effectiveness of clinicians’ practice (Reiman 1988) and standardised measures make that job more consistent, comparable and valid (Cole et al 1994). Hand therapists have long recognised the need for the standardisation of outcome measures, particularly for performance-based measures such as strength testing (Mathiowetz et al 1985, Woody et al 1988) or joint motion. More recently there has been an increased interest in outcome measures that capture the patient's perspective of their status, and that are standardised. The DASH (Disabilities of the Arm, Shoulder and Hand) is a standardised outcome measure that could be used for this purpose (Hudak et al 1996, McConnell et al 1999). The DASH reflects the impact of a disorder in terms of physical function and symptoms, which are the two main reasons patients seek care for a disorder of the musculoskeletal system. The DASH is becoming widely used by clinicians and researchers (McConnell et al 1999). It is now important to revisit what we know about how well the DASH is able to measure what it purports to measure. The purpose of this paper is to review the research that has been done to date on the DASH outcome measure, and to describe the implications of this for future research and for clinical practice.

Psychometric Evaluation of the Caring Nurse Observation Tool: Scale Development

2012 ◽  
Vol 16 (1) ◽  
pp. 16-25
Author(s):  
Sylvie Cossette, ◽  
Catherine Forbes,
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Reliability Assessment ◽  
Real Life ◽  
Psychometric Evaluation ◽  
Role Playing ◽  
Rater Agreement ◽  
Validity Assessment ◽  
Patient Interactions ◽  
The Impact

This paper describes the development and reliability assessment of the Caring Nurse Observation tool (CNOT), which includes measures of verbal and non-verbal caring interactions. Using Watson caring and Watzlawick communication theories, observable indicators of caring were selected. After a content validity assessment, the 43 indicators of the tool were tested for inter-rater reliability using both role-playing and real-life nurse-patient interactions. Mean inter-rater agreement was 38% and 41%, respectively, in the two datasets, indicating reliability of the tool. the CNOT will aid nurses to document and demonstrate the impact of caring attitudes on health outcomes in research and clinical practice.

Impact of cancer survivorship care plans (SCPs) on health outcomes and health care delivery: A systematic review.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 2-2 ◽  
Author(s):  
Paul B. Jacobsen ◽  
Antonio P. Derosa ◽  
Tara O. Henderson ◽  
Deborah Mayer ◽  
Chaya S. Moskowitz ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Care Delivery ◽  
Well Being ◽  
Cochrane Library ◽  
Satisfaction With Care ◽  
Survivorship Care ◽  
Care Plans ◽  
Randomized Studies ◽  
Patient Reported ◽  
The Impact

2 Background: In 2006, the Institute of Medicine recommended that patients at or near completion of active treatment be provided with a SCP (treatment summary, relevant health information, and follow-up care plan) to improve care delivery and outcomes in the post-treatment period. We systematically reviewed published research to determine if SCPs have a positive impact on health outcomes and healthcare delivery. Methods: Randomized and nonrandomized studies evaluating patient-reported outcomes, healthcare utilization, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, and Cochrane Library. Data were extracted by independent raters and summarized based on qualitative synthesis. Results: Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer diagnoses, timing of SCP delivery in relation to treatment completion, SCP delivery method and recipients, SCP content, SCP-related counseling, and outcomes assessed. Findings from nonrandomized studies yielded descriptive information only on outcomes such as satisfaction with care and reactions to SCPs. Among randomized studies, findings were near uniformly negative for the impact of SCPs on the most commonly assessed outcomes (physical, functional, and psychological well-being); findings were positive in single studies for other outcomes including amount of information received, satisfaction with care, and physician implementation of recommended survivorship care. Conclusions: Existing research provides minimal evidence that SCPs improve quality of life in cancer survivors. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal health outcomes. Findings are very limited but more positive for proximal outcomes (e.g., information received) and for care delivery, especially when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. In light of current findings, future research should focus to a greater extent on evaluating ways to ensure SCP recommendations are subsequently implemented as part of ongoing care.

scholarly journals A narrative review of current evidence supporting the implementation of electronic patient-reported outcome measures in the management of chronic diseases

2021 ◽  
Vol 12 ◽  
pp. 204062232110159
Author(s):  
Olalekan Lee Aiyegbusi ◽  
Devika Nair ◽  
John Devin Peipert ◽  
Kara Schick-Makaroff ◽  
Istvan Mucsi
Keyword(s):  
Clinical Practice ◽  
Chronic Diseases ◽  
Patient Reported Outcomes ◽  
Healthcare Providers ◽  
Patient Reported Outcome ◽  
Routine Clinical Practice ◽  
Narrative Review ◽  
Current Evidence ◽  
Patient Reported ◽  
The Impact

An application of telemedicine of growing interest and relevance is the use of personal computers and mobile devices to collect patient-reported outcomes (PROs). PROs are self-reports of patients’ health status without interpretation by anyone else. The tools developed to assess PROs are known as patient-reported outcomes measures (PROMs). The technological innovations that have led to an increased ownership of electronic devices have also facilitated the development of electronic PROMs (ePROMs). ePROMs are a conduit for telemedicine in the care of patients with chronic diseases. Various studies have demonstrated that the use of ePROMs in routine clinical practice is both acceptable and feasible with patients increasingly expressing a preference for an electronic mode of administration. There is increasing evidence that the use of electronic patient-reported outcome (ePROMs) could have significant impacts on outcomes valued by patients, healthcare providers and researchers. Whilst the development and implementation of these systems may be initially costly and resource-intensive, patient preferences and existing evidence to support their implementation suggests the need for continued research prioritisation in this area. This narrative review summarises and discusses evidence of the impact of ePROMs on clinical parameters and outcomes relevant to chronic diseases. We also explore recently published literature regarding issues that may influence the robust implementation of ePROMs for routine clinical practice.

The impact a surgeon has on primary amputee prosthetic rehabilitation: A survey of residual lower limb quality

2018 ◽  
Vol 42 (4) ◽  
pp. 428-436 ◽  
Author(s):  
Sellaiah Sooriakumaran ◽  
Maggie Uden ◽  
Sarah Mulroy ◽  
David Ewins ◽  
Thomas Collins
Keyword(s):  
Lower Limb ◽  
Limb Amputation ◽  
Residual Limb ◽  
Surgical Results ◽  
Prosthetic Rehabilitation ◽  
Rehabilitation Centre ◽  
Rehabilitation Professionals ◽  
High Standards ◽  
Key Aspects ◽  
The Impact

Background: Substantial improvements have been perceived in surgical results following major lower limb amputation, but there remains observed variation in amputation quality for patients referred for prosthetic rehabilitation from different hospitals. Objectives: To assess various elements that influence residual limb quality and evaluate their impact on progress through initial prosthetic rehabilitation and mobility outcome after rehabilitation. Study design: Clinical survey. Methods: A revised 10-item residual limb scoring system was used to survey a succession of 95 primary amputees with transtibial and transfemoral amputations (100 residual limbs) presenting for rehabilitation. Results: The majority of residual limbs scored highly, supporting the perception of generally good amputation quality. There were significant differences in average residual limb scores between some hospitals. The overall scores showed weak or minimal correlation to progress through rehabilitation and mobility outcome but residual limbs scoring higher in seven of the items of the score showed significant advantages in key aspects of progress or mobility at discharge. Conclusion: There is need for continued collaboration between surgeons and rehabilitation centres to ensure consistent high standards. The revised residual limb score used in this survey needs further refinement for future use. Clinical relevance Residual limb quality is an important component influencing prosthetic rehabilitation. This survey of residual limbs at one Rehabilitation Centre suggests encouragingly good surgical results but highlights differences between hospitals. A particular issue is the need for effective collaboration between surgeons and prosthetic rehabilitation professionals to optimise residual limb preparation.

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