Density of Patient-Sharing Networks: Impact on the Value of Parkinson Care

Background: Optimal care for Parkinson’s disease (PD) requires coordination and collaboration between providers within a complex care network. Individual patients have personalised networks of their own providers, creating a unique informal network of providers who treat (‘share’) the same patient. These ‘patient-sharing networks’ differ in density, ie, the number of identical patients they share. Denser patient-sharing networks might reflect better care provision, since providers who share many patients might have made efforts to improve their mutual care delivery. We evaluated whether the density of these patient-sharing networks affects patient outcomes and costs. Methods: We analysed medical claims data from all PD patients in the Netherlands between 2012 and 2016. We focused on seven professional disciplines that are commonly involved in Parkinson care. We calculated for each patient the density score: the average number of patients that each patient’s providers shared. Density scores could range from 1.00 (which might reflect poor collaboration) to 83.00 (which might reflect better collaboration). This score was also calculated at the hospital level by averaging the scores for all patients belonging to a specific hospital. Using logistic and linear regression analyses we estimated the relationship between density scores and health outcomes, healthcare utilization, and healthcare costs. Results: The average density score varied considerably (average 6.7, SD 8.2). Adjusted for confounders, higher density scores were associated with a lower risk of PD-related complications (odds ratio [OR]: 0.901; P<.001) and with lower healthcare costs (coefficients: -0.018, P=.005). Higher density scores were associated with more frequent involvement of neurologists (coefficient 0.068), physiotherapists (coefficient 0.052) and occupational therapists (coefficient 0.048) (P values all <.001). Conclusion: Patient sharing networks showed large variations in density, which appears unwanted as denser networks are associated with better outcomes and lower costs.

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Patient Response Toward a Change in the System of Health Care Delivery

PEDIATRICS ◽

10.1542/peds.52.2.289 ◽

1973 ◽

Vol 52 (2) ◽

pp. 289-293

Author(s):

Kathleen J. Motil ◽

W. John Siar

Keyword(s):

Health Care ◽

Health Care Delivery ◽

Care Delivery ◽

Poor Quality ◽

Emergency Rooms ◽

Patient Response ◽

Number Of Patients ◽

Comprehensive Health ◽

Crisis Care

With the emphasis being placed on comprehensive health care, outpatient clinics in major city hospitals have found it necessary to reevaluate their methods of health care delivery. An increasing number of patients who fail to schedule or keep medical appointments appear for crisis care, resulting in a higher cost of hospital operation due to unnecessary utilization of emergency rooms and the wasting of time of clerical and professional personnel, as well as poor quality of health care due to See the Table in PDF File sporadic clinic attendance. When comparing behavior patterns and attitudes of clinic patients under different methods of health care delivery, patient preferences become apparent.

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Value-Based HIV Care: A Method to Improve Quality of HIV Care.

10.21203/rs.3.rs-117180/v1 ◽

2020 ◽

Author(s):

Guido van den berk ◽

Daoud Ait Moha ◽

Janneke Stalenhoef ◽

Marie-Jose Kleene ◽

Narda van der Meche ◽

...

Keyword(s):

Quality Of Life ◽

Care Delivery ◽

Population Level ◽

Care Quality ◽

Hiv Care ◽

First Year ◽

Outcome Indicators ◽

Number Of Patients ◽

Care Path

Abstract Background : To support our goal of providing optimal HIV care to our patients, we started applying the value-based health care principle to the HIV care that we offer in our HIV center, measuring relevant health outcomes and costs to allow continuous implementation of improvements (Value-Based HIV Care; VBHiC). Methods : In line with the principles of Michael Porter, our approach consisted of the following steps: 1) Organizing into integrated practice units / describing the HIV care path; 2) Defining an HIV outcome indicator set; 3) Building an enabling information technology platform; 4) Integrating care delivery across separate facilities; 5) Moving to bundled payments for care cycles and 6) Expanding excellent services and interventions for improvement across geographic boundaries. Results : The following set of 9 outcome indicators was developed: undetectable HIV load within the first year of care; quality of life within the first year of care; mortality within the first year of care; retention in care; therapy effectiveness; therapy tolerance; cardiovascular risk; quality of life for every subsequent year and overall annual mortality. These indicators, which were evaluated retrospectively, are shown in figures 1-5. Collection of the underlying data started in January 2016. The HIV care path was also integrated into the electronic file system. Creation of the ability to monitor outcome indicators at patient level, population level and process level allowed us to implement a quality cycle (plan-do-study-act). Conclusion : Our Value-Based HIV Care approach facilitated structured evaluation of parameters that are of value to the patient. It also boosted the quality of the HIV care that we provide and allowed us to increase the number of patients to whom we can offer high quality HIV care.

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The Lived Experience of Nurses Caring for Patients Diagnosed With Intravenous Drug Use–Associated Infective Endocarditis in Appalachia: A Phenomenological Study

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211037735 ◽

2021 ◽

pp. 107839032110377

Author(s):

Kendrea L. Todt ◽

Sandra P. Thomas

Keyword(s):

Substance Use ◽

Infective Endocarditis ◽

Drug Use ◽

Substance Use Disorder ◽

Phenomenological Study ◽

Care Delivery ◽

Intravenous Drug ◽

Intravenous Drug Use ◽

Central Theme ◽

Number Of Patients

BACKGROUND: The number of patients admitted with infective endocarditis (IE) from intravenous drug use (IVDU) in Appalachia is increasing, a direct downstream effect of the opioid crisis. Extant literature highlights the pejorative attitudes health care workers have toward patients with substance use disorder, with nurses among the most punitive. Rather than describe attitudes, the purpose of this study was to describe the lived experiences of nurses caring for patients diagnosed with IE from IVDU in Appalachia. OBJECTIVE: To describe an unexplored phenomenon in Appalachia to inform nursing practice, nursing education, and health policy. METHOD: Qualitative phenomenological study using the University of Tennessee method based on the tenets of Maurice Merleau-Ponty. Nine nurses (ages 29-53 years) recruited using purposive and snowball sampling participated in unstructured phenomenological interviews. RESULTS: The essential meaning or central theme of the nurse experience working with these patients was a sense of hopelessness/hope, with four interrelated themes derived from the central theme: (1) guarding/escaping, (2) responsibility and revulsion, (3) apathy/empathy, and (4) grief and sorrow/cold and unemotional. Universally, nurses perceived caring for this population as futile, feeling a sense of powerlessness to change the outcome. CONCLUSIONS: These care experiences frustrated nurses, who described being physically and emotionally drained. To improve care delivery and improve patient outcomes, emphasis must be placed on nurse addiction education and standardizing nurse to patient with substance use disorder ratios to decrease work-related stress on nurses.

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2008 Alexander S. Nadas Lecture—Repaired, Not Cured

Circulation ◽

10.1161/circ.118.suppl_18.a_13-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Amnon Rosenthal

Keyword(s):

Primary Care ◽

School Health ◽

Care Physician ◽

Care Plan ◽

Congenital Defects ◽

Optimal Care ◽

Term Care ◽

Cardiac Defects ◽

Number Of Patients ◽

Medical Advances

A large number of patients with congenital cardiac disease have a repaired but not cured malformation. Although some mild cardiac defects may heal spontaneously, others persist or progress with advancing age. Among those with a major or complex defect repaired by interventional and/or surgical procedures, few are cured. Whereas major cardiac defects often occur as an isolated anomaly, many patients have serious extracardiac congenital defects, systemic syndromes, genetic abnormalities, or other handicaps. In caring for the patient, the pediatric cardiologist, in addition to directing cardiac therapy, is often called upon to coordinate the diverse care, plan, and guide for the patient’s future. It is a chronic disorder often recognized in the fetus, proceeding through infancy, childhood, and into adulthood, thus requiring long-term care. The medical and surgical therapy is usually provided by subspecialist colleagues within the field. However, delivery of appropriate, comprehensive, and optimal care requires a “quarterback” cardiologist concerned with diverse, frequently inevitable issues, such as prematurity, nutrition, growth, or genetic screening. Important concomitant problems may be related to associated extracardiac anomalies, exercise capacity, school, health or life insurance, employment, pregnancy, and family life. A primary care physician might be uncomfortable advising on many of these issues and the responsibility falls to the cardiologist. Anticipated medical advances may further impact the care and require yet greater coordination of services and close empathetic attention. These changes may include further cardiologist subspecialization, primary care provided by nurse clinicians, fetal cardiac intervention, increase in regionalization of specialty care, or more complex laboratory procedures—all not infrequently replacing the careful medical history and physical examination.

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ADDRESSING COVID-19 IN KAZAKHSTAN: WHAT ARE THE EFFORTS AND CHALLENGES?

Vestnik ◽

10.53065/kaznmu.2021.41.35.060 ◽

2021 ◽

pp. 289-292

Author(s):

Л.Ж. Алекешева ◽

К.К. Тогузбаева ◽

К.О. Джусупов

Keyword(s):

Social Services ◽

Herd Immunity ◽

Health Indicators ◽

Risk Groups ◽

Medical Services ◽

New Disease ◽

Optimal Care ◽

Number Of Patients ◽

Coronavirus Infection ◽

The Impact

COVID-19 нанес серьезный удар по системам здравоохранения многих стран мира, включая Республику Казахстан. Чтобы справиться с пандемией, Казахстан разработал план, содержащий три стратегические цели: 1) предотвращение вспышки болезни; 2) Обеспечение оптимального ухода для всех пациентов и 3) Сведение к минимуму воздействия пандемии на системы здравоохранения, социальные услуги и экономическую деятельность. Однако неравномерное распределение финансовых ресурсов по регионам, нерегулярное потребление медицинских услуг и различия в показателях здоровья препятствуют этим усилиям. Другие проблемы - это нехватка медицинских сил, неожиданность ситуации, отсутствие знаний о коронавирусной инфекции и бессилие перед этой новой болезнью. Были трудности с массовым тестированием, поскольку стигма и страх перед карантином вынуждали людей не проходить тестирование. После отмены чрезвычайного положения и строгой изоляции страну охватила эйфория, которая привела к резкому увеличению числа случаев заболевания. Чтобы взять ситуацию под контроль в июне 2020 года был экстренно введен второй локдаун, постепенно стало уменьшаться количество больных и инфицированных. Пандемия показала, насколько хрупка и зависима система: была отложена плановая вакцинация детям до 1 года, временно приостановлено медицинское обследование и оказание медицинских услуг больным хроническими, онкологическими заболеваниями, плановая госпитализация. Многие врачи и медсестры заразились и заболели. На момент написания этой статьи эпидемиологическая ситуация в стране с COVID-19 находится под контролем и надзором, однако давать какие-либо прогнозы относительно его завершения пока рано. Казахстан готовится к вакцинации от коронавирусной инфекции, в первую очередь вакцинации должны подвергаться группы риска, медицинские и социальные работники, а также люди с хроническими заболеваниями. Пока коллективный иммунитет не сформирован, казахстанцы должны проявлять осторожность при снятии ограничений, чтобы предотвратить взрыв новых случаев заболевания. COVID-19 has strained the healthcare systems of many countries worldwide including the Republic of Kazakhstan. To cope with the pandemic, Kazakhstan mounted a plan containing three strategic objectives: 1) Preventing the outbreak of the disease; 2) Ensuring optimal care for all patients, and 3) Minimizing the impact of the pandemic on health systems, social services, and economic activities. However, the uneven distribution of financial resources across regions, irregular consumption of medical services, and inconsistent health indicators hamper these efforts. Other issues are the lack of medical forces, the unexpectedness of the situation, lack of knowledge on coronavirus infection, and powerlessness in front of this new disease. There were difficulties in mass testing as stigma and fear from quarantine forced people not to get tested. The euphoria enveloped the country after abolishing the emergency state after an intense lockdown which resulted in increased cases. A second lockdown was urgently introduced in June 2020 to take control of the situation. The number of patients and those infected gradually began to decline. The pandemic showed the fragility and inter-dependence of the health system- planned vaccinations against many infectious diseases were postponed. Medical examination and provision of medical services to patients with chronic, oncological diseases, planned hospitalization were temporarily halted. Many doctors and nurses became infected and ill. The country's COVID-19 epidemiological situation is somewhat under the control and supervision as of this writing. However, to give any forecasts for its completion is still too early. Kazakhstan is preparing to vaccinate against coronavirus infection. First of all, risk groups, medical and social workers, and people with chronic diseases should be subject to vaccination. Until herd immunity is not formed, Kazakhstanis must keep caution when the restrictions are taken off to prevent an explosion of new disease cases.

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Clinical engagement: a new concept or common sense all round?

Australian Health Review ◽

10.1071/ah18010 ◽

2019 ◽

Vol 43 (4) ◽

pp. 392

Author(s):

Stephen Bolsin ◽

Jenny Carter ◽

Aileen Kitson ◽

Donna Walter ◽

Stephen Roberts

Keyword(s):

Patient Outcomes ◽

Common Sense ◽

Employee Satisfaction ◽

Clinical Governance ◽

Healthcare Organisation ◽

Number Of Patients ◽

Clinical Engagement ◽

To Receive ◽

Professional Disciplines

Clinical engagement has supplemented clinical governance in healthcare to strengthen the contribution of medical professionals to the assessment of clinical outcomes for patients. Assessments of clinical engagement have, until now, been qualitative; this case study introduces the concept of quantitative assessment of clinical engagement by measuring the number of patients managed according to specialist society guidelines. Such an assessment engages all staff (medical, nursing, allied health and pharmacy) involved in patients receiving treatment according to such guidelines and provides an assessment of individual and organisational compliance with those guidelines. Clinical engagement is then quantified as the percentage of patients that have been documented to receive specialist society- or college-approved guideline-compliant treatment, relative to the total number who could receive such treatment, in any healthcare organisation. What is known about the topic? Clinical engagement has emerged in recent years as a virtue to be encouraged in healthcare organisations because of its association with improved patient outcomes and employee satisfaction. Assessments have relied on repeated staff surveys in order to gauge engagement. What does this paper add? This paper proposes a novel means of measuring clinical engagement in an organisational setting. The vision put forward is that adherence to clinical guidelines in an organisation measures clinician engagement across professional disciplines. What are the implications for practitioners? The implications are that organisations will contribute to measuring the adherence of specialty groups of clinicians to guidelines that the clinicians select and use the data for individual and organisational accreditation.

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Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

Journal of Institute of Medicine ◽

10.3126/jiom.v41i1.28603 ◽

2019 ◽

Vol 41 (1) ◽

pp. 67-74

Author(s):

Shubha K Shrestha ◽

Bishwas Pradhan ◽

Yogendra M Shakya ◽

Hem R Paneru

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

University Teaching ◽

Chronic Obstructive ◽

Optimal Care ◽

Obstructive Pulmonary Disease ◽

Number Of Patients ◽

Common Diagnosis ◽

The Common ◽

A Prospective Study

Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH. Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study. Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation (AE) of Chronic Obstructive Pulmonary Disease (COPD), Pneumonia and Chronic Kidney Disease (CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min). Conclusion: Among critically ill patients presenting to our ER, almost 1/5th of the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients.

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Management of Canadian Pediatric Patients With Glomerular Diseases During the COVID-19 Pandemic: Recommendations From the Canadian Association of Pediatric Nephrologists COVID-19 Rapid Response Team

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120970713 ◽

2020 ◽

Vol 7 ◽

pp. 205435812097071

Author(s):

Cal Robinson ◽

Michelle Ruhl ◽

Amrit Kirpalani ◽

Abdullah Alabbas ◽

Damien Noone ◽

...

Keyword(s):

Kidney Disease ◽

Peer Review ◽

Care Delivery ◽

Rapid Response Team ◽

Glomerular Disease ◽

Rapid Response ◽

Optimal Care ◽

Glomerular Diseases ◽

Canadian Association ◽

Response Team

Purpose: The goal of these recommendations is to provide guidance on the optimal care of children with glomerular diseases during the COVID-19 pandemic. Patients with glomerular diseases are known to be more susceptible to infection. Risk factors include decreased vaccine uptake, urinary loss of immunoglobulins, and treatment with immunosuppressive medications. The Canadian Society of Nephrology (CSN) recently published guidelines on the care of adult glomerulonephritis patients. This guideline aims to expand and adapt those recommendations for programs caring for children with glomerular diseases. Sources of information: We used the CSN COVID-19 Rapid Response Team adult glomerulonephritis recommendations, published in the Canadian Journal of Kidney Health and Disease, as the foundation for our guidelines. We reviewed documents published by nephrology and non-nephrology societies and health care agencies focused on kidney disease and immunocompromised populations. Finally, we conducted a formal literature review of publications relevant to pediatric and adult glomerular disease, chronic kidney disease, hypertension, and immunosuppression in the context of the COVID-19 pandemic. Methods: The leadership of the Canadian Association of Pediatric Nephrologists (CAPN), which is affiliated with the CSN, identified a team of clinicians and researchers with expertise in pediatric glomerular diseases. The aim was to adapt Canadian adult glomerulonephritis guidelines to make them applicable to children and discuss pediatric-specific considerations. The updated guidelines were peer-reviewed by senior clinicians with expertise in the care of childhood glomerular diseases. Key findings: We identified a number of key areas of glomerular disease care likely to be affected by the COVID-19 pandemic, including (1) clinic visit scheduling, (2) visit types, (3) provision of multidisciplinary care, (4) blood work and imaging, (5) home monitoring, (6) immunosuppression, (7) other medications, (8) immunizations, (9) management of children with suspected COVID-19, (10) renal biopsy, (11) patient education and support, and (12) school and child care. Limitations: There are minimal data regarding the characteristics and outcomes of COVID-19 in adult or pediatric glomerular disease patients, as well as the efficacy of strategies to prevent infection transmission within these populations. Therefore, the majority of these recommendations are based on expert opinion and consensus guidance. To expedite the publication of these guidelines, an internal peer-review process was conducted, which may not have been as rigorous as formal journal peer-review. Implications: These guidelines are intended to promote optimal care delivery for children with existing or newly diagnosed glomerular diseases during the COVID-19 pandemic. The implications of modified care delivery, altered immunosuppression strategies, and limited access to existing resources remain uncertain.

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Improving Nutrition Care, Delivery, and Intakes Among Hospitalised Patients: A Mixed Methods, Integrated Knowledge Translation Study

Nutrients ◽

10.3390/nu11061417 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1417 ◽

Cited By ~ 1

Author(s):

Shelley Roberts ◽

Lauren T. Williams ◽

Ishtar Sladdin ◽

Heidi Neil ◽

Zane Hopper ◽

...

Keyword(s):

Knowledge Translation ◽

Care Delivery ◽

Hospital Staff ◽

Medical Ward ◽

Integrated Knowledge Translation ◽

Post Intervention ◽

Nutrition Care ◽

Hospitalised Patients ◽

Number Of Patients ◽

Integrated Knowledge

Malnutrition is a common and complex problem in hospitals. This study used an integrated knowledge translation approach to develop, implement, and evaluate a multifaceted, tailored intervention to improve nutrition care, delivery, and intake among acute medical inpatients. This observational, pre-post study was conducted in a medical ward at a public hospital in Australia. The intervention was co-developed with key stakeholders and targeted three levels: individuals (nutrition intake magnets at patient bedsides), the ward (multidisciplinary hospital staff training), and the organisation (foodservice system changes). Observational data were collected pre- and post-intervention on patient demographics, food intakes, and the mealtime environment. Data were entered into SPSS and analysed using descriptive and inferential statistics. Ethical approval was gained through the hospital and university ethics committees. A total of 207 patients were observed; 116 pre- and 91 post-intervention. After intervention implementation, patients’ mean energy and protein intakes (in proportion to their estimated requirements) were significantly higher and the number of patients eating adequately doubled (p < 0.05). In summary, a multifaceted, pragmatic intervention, tailored to the study context and developed and implemented alongside hospital staff and patients, seemed to be effective in improving nutrition practices and patient nutrition intakes on an acute medical ward.

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Cost implications of growth in new cancer drugs in a comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.112 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 112-112

Author(s):

Sukanya Murali Venkatesan ◽

Anamika Chaudhuri ◽

Belen Fraile

Keyword(s):

Care Delivery ◽

Fiscal Year ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Cancer Therapies ◽

Hospital Data ◽

Total Cost ◽

Number Of Patients ◽

Number Of Visits ◽

Cost Implications

112 Background: Rising costs of cancer therapies calls for strategizing towards sustainable care delivery models from a hospital planning, payer as well as policy-making perspective. This topic becomes increasingly significant as there is exponential growth of novel, high-cost immunotherapy drugs making it imperative for players to adopt and practice value-based oncology. Objective: This study aims to evaluate increasing trends in use of new and transformative cancer therapies, and associated drug costs in a comprehensive cancer center in Massachusetts. Methods: Study period was fiscal year (FY) 2015-2018. Utilization was defined by the number of patients receiving infusion and number of visits made by them to the center during the FY. Cost was defined as expense to hospital. Data source was hospital billing database. ASP (Average Sales Price) of drug was obtained from CMS website and was used as an indicator for cost per unit of the drug. Results: Top 10 drugs were identified based on total cost incurred in the study period and contributed to almost a third of center’s total cost. Over the three years, number of visits for these drugs grew up to 700% and treated patients grew up to 350%. Use of chemotherapy in isolation decreased from 35% of treated patients in FY15 to 26% in FY18, whereas its use in combination with immunotherapy increased from 22% in FY15 to 28% in FY18. Average drug cost to hospital per patient for the study period ranged as high as $120,000 (excluding non-drug treatment costs). Conclusions: While clinical value of the new cancer therapies is unquestionably significant, there is a dire need for policy-makers, providers and payers alike to pay continued attention towards its high cost implications as observed in this study and, continue striving towards establishing more sustainable pricing policies through alternative payment models.

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