scholarly journals Challenging incidents in health centers and how to deal with it: Physician–Patient bad interactions

2021 ◽  
Vol 1 (4) ◽  
pp. e284
Author(s):  
Feroza Fatima ◽  
Waad Ibrahim Kadori
Keyword(s):  
Health Outcomes ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Health Centers ◽  
Patient Health ◽  
Patient Relationships ◽  
Physician Patient ◽  
The Relationship ◽  
Improve Patient

The physician-patient rapport is the basis of patient care and can have profound implications on clinical outcomes. Ultimately, the principal objective of the physician-patient rapport is to improve patient health outcomes. Stronger physician-patient relationships are correlated with improved patient outcomes. As the relationship between physicians and patients becomes more important, it is essential to understand the factors that influence this relationship.

Embracing the Quadruple Aim: One hospital’s experience

2020 ◽  
Vol 34 (1) ◽  
pp. 26-28
Author(s):  
Mike Lapaine
Keyword(s):  
Health Outcomes ◽  
Employee Engagement ◽  
Patient Outcomes ◽  
Patient Experience ◽  
Triple Aim ◽  
Quadruple Aim ◽  
Patient Health ◽  
Reduced Costs ◽  
Improve Patient

Healthcare institutions have for some time pursued the Triple Aim: improve patient health outcomes, improve patient experience, and reduce costs. More recently, it has been recognized that the “missing piece” of success is to improve the experience of their clinicians in order to improve the three aims. The leadership of Bluewater Health has been using the Quadruple Aim since 2016 and, by working to improve employee engagement, has succeeded in also delivering exemplary care that has improved patient outcomes and experience and reduced costs.

Integrating social class and privilege in the community medicine curriculum

2017 ◽  
Vol 52 (3) ◽  
pp. 228-235
Author(s):  
Christopher Haymaker ◽  
Amber Cadick ◽  
Allison Seavey
Keyword(s):  
Social Class ◽  
Hidden Variables ◽  
Therapeutic Approaches ◽  
Physician Patient Relationship ◽  
Health Curriculum ◽  
Group Format ◽  
Resident Physicians ◽  
Patient Health ◽  
Patient Relationships ◽  
Physician Patient

Social class and privilege are hidden variables that impact the physician–patient relationship and health outcomes. This article presents a sample of activities from three programs utilized in the community health curriculum to teach resident physicians about patients within context, including how social class and privilege impact physician–patient relationships and patient health. These activities address resident physicians’ resistance to discussion of privilege, social class, and race by emphasizing direct experience and active learning rather than traditional didactic sessions. The group format of these activities fosters flexible discussion and personal engagement that provide opportunities for reflection. Each activity affords opportunities to develop a vocabulary for discussing social class and privilege with compassion and to adopt therapeutic approaches that are more likely to meet patients where they are.

Conceptualizing Narrative Health and Medicine to Develop Cultural Competence to Improve Communication During the COVID-19 Pandemic

2021 ◽  
Vol 8 (1) ◽  
pp. 32-36
Author(s):  
Kent Willis ◽  
Colleen Marzilli
Keyword(s):  
Healthcare Professional ◽  
Cultural Competence ◽  
Severe Acute Respiratory Syndrome ◽  
Patient Care ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
Important Concept ◽  
Healthcare Environment ◽  
Health Narrative ◽  
Improve Patient

Narrative health is a technique that healthcare professionals can use to connect with patients. The events of 2020, including the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have identified that patient care is largely dependent upon relationships within the healthcare environment. Relationships in the healthcare environment are established through a trusting exchange between the patient and provider, and one technique to develop this relationship and trust is through narrative health. Narrative health provides the exchange of information between patient and provider in a discussion-like manner, or narrative health. This strategy promotes cultural competence amongst the healthcare professional team and improves communication between the patient and provider. Narrative health is an important concept for healthcare professionals to understand, and narrative health should be a part of any healthcare professional’s toolbox, especially in vulnerable times like the COVID pandemic. The inclusion of narrative health in practice has the potential to improve patient outcomes and empower healthcare professionals and patients.

scholarly journals Communication with the Migraine Patient

2002 ◽  
Vol 29 (S2) ◽  
pp. S1-S2 ◽  
Author(s):  
W.J. Becker
Keyword(s):  
Patient Outcomes ◽  
Communication Skills ◽  
Migraine Patient ◽  
Laboratory Tests ◽  
Good Communication ◽  
The Past ◽  
Physician Patient Communication ◽  
Physical Findings ◽  
Physician Patient ◽  
Improve Patient

Much has been added to our knowledge of effective physician-patient communication by the research of the past two decades. Good communication skills are especially important for the clinician dealing with a migraine patient, as neither laboratory tests nor diagnostic physical findings are available to assist the physician in diagnosis and treatment. It is important for clinicians to understand that effective communication skills can be taught and learned and that, once mastered, they have the potential to improve patient outcomes.

Achieving patient health outcomes via CME: A case-study in educating oncologists in the treatment of non-small cell lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19104-e19104
Author(s):  
Tom Bregartner
Keyword(s):  
Health Outcomes ◽  
Educational Activities ◽  
Nccn Guidelines ◽  
Tumor Pathology ◽  
Measurement Tools ◽  
Patient Health ◽  
Chart Audits ◽  
Improve Patient

e19104 Background: The Validation Model is an educational series built on the concept of strengthening education by incorporating the patient perspective. After conducting two iterations of the Validation Model to educate oncologists in the treatment of NSCLC, Quintiles Medical Education was able to demonstrate that CME can lead to improved patient health outcomes by changing physician behaviors in practice. Educational measurement tools, including chart audits, revealed an increase in tumor histology and EGFR mutation testing. Histologic and molecular marker testing leads to optimization of treatment based on tumor pathology and genotype, respectively, as per NCCN guidelines. Personalization of treatment according to guidelines results in improved health outcomes. Methods: The Validation Model consisted of 6 educational activities for which efficacy was measured by conducting pre- and post-tests of knowledge and clinical competence among participants. Participants were then asked to complete a follow-up survey which was designed to determine if specific practices had been implemented since participation. The self-self reported behavioral data was validated by the distribution of patient surveys, designed to measure patient satisfaction and expectation with care, and chart audits, designed to determine the actual practice habits of the participating practitioners. Results: More than 500 participants have completed all 6 of the educational activities. The activities have demonstrated improved knowledge and competence in the educational setting and changes to clinical practice and, as a result, patient health outcomes. Conclusions: CME can be used as an effective tool to improve patient health outcomes in the treatment of NSCLC.

scholarly journals Orthopedic Research: A golden opportunity to improve patient outcomes

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Site Administrator ◽  
Czar Louie Gaston
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Fracture Liaison Service ◽  
The Philippines ◽  
Evidence Based ◽  
The Core ◽  
Fracture Liaison Services ◽  
Randomized Controlled ◽  
Fracture Liaison ◽  
Improve Patient

Research has been one of the core pillars of the Department of Orthopedics of the Philippine General Hospital over its now 50 years of existence. The department established one of the earliest resident’s research contests in the hospital in 1983 and its graduates regularly publish in peer reviewed journals and present their results in international conferences.1 Residents are required to complete 2 original studies prior to graduation and encouraged to document their clinical cases fully for future observational studies. Despite the apparent fascination, questions remain for a lot of trainees and clinicians. “Why do research? How does it  help our patients?” Skepticism abounds as even clinically sound and well-made studies oftentimes do not lead to policy and practice changes needed to improve patient care.2 Given contrarian evidence from randomized controlled trials (RCTs), practices of most established surgeons do not change.3 Hope remains however as evidence-based practice in orthopedics is growing and here to stay.4 Surgeons who accurately examine and diagnose their patient, keep medical records, analyze the medical literature for the best treatment, and explain the available options are subconsciously practicing the scientific methods of observation, documentation, analysis, and reporting conclusions which are the basis of all scientific research. Incorporating research education not just to residency training programs but also to continuing medical education (CME) courses for surgeons may help develop the skills to comprehend new studies and incorporate them into patient care. Reassuringly for the elder surgeon, even old dogs have been shown to learn new tricks for their practice, just not as fast as the younger generation.5 The challenge now presented to Philippine medical practitioners is to develop clinical research that will translate into improved care for patients. As majority of literature dictating treatment for musculoskeletal disorders come from developed countries, case series or observational cohorts reporting local data in our setting is greatly important in guiding patient care.6 The fundamental goal is to produce high quality studies or new breakthroughs that engage discussion amongst a wide audience and lead to system changes that eventually enhance patient outcomes.7 As part of the celebration of the PGH Department of Orthopedics 50th golden anniversary, this orthopedic issue of the ACTA MEDICA PHILIPPINA represents work from the different orthopedic subspecialities of the department and its graduates. Pioneering studies on brachial plexus injuries, computer navigated spine surgery, rotationplasty, artificial intelligence, pedagogy, and much more highlight the growth of orthopedics in the Philippines. A study on one of the newest fields in Philippine orthopedics, orthogeriatrics, exemplifies the importance of blazing a new trail. The publication by Reyes et al. on a multidisciplinary orthogeriatric approach to the treatment of fragility hip fractures has shown improved outcomes consistent with the positive results of other fracture liaison services in Asia and worldwide.8,9 Their work has since led to the UPM-PGH Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service being adopted by PGH as a clinical pathway and has served as a model for other hospitals in the Philippines to improve their care of patients with fragility hip fractures. With the follow-through from the initial clinical study to administrative and policy changes, this example aptly illustrates the power of research to effect significant improvements in clinical outcomes and inspires all of us to continue to strive for better care for our patients.   Czar Louie Gaston, MD, FPOA Department of Orthopedics Philippine General Hospital University of the Philippines Manila   REFERENCES College of Medicine University of the Philippines Manila. Orthopedics [Internet]. [cited 2021 May]. Available from: https://cm.upm.edu.ph/p/orthopedics/ Buchbinder R, Maher C, Harris IA. Setting the research agenda for improving health care in musculoskeletal disorders. Nat Rev Rheumatol. 2015 Oct;11(10):597-605. doi: 10.1038/nrrheum.2015.81. Epub 2015 Jun 16. PMID: 26077917. Sonntag J, Landale K, Brorson S, Harris IA. Can the results of a randomized controlled trial change the treatment preferences of orthopaedic surgeons? Bone Jt Open. 2020 Sep 11;1(9):549-555. doi: 10.1302/2633-1462.19.BJO-2020-0093.R1. PMID: 33215153; PMCID: PMC7659699. Griffin XL, Haddad FS. Evidence-based decision making at the core of orthopaedic practice. Bone Joint J. 2014 Aug;96-B(8):1000-1. doi: 10.1302/0301-620X.96B8.34614. PMID: 25086112. Niles SE, Balazs GC, Cawley C, Bosse M, Mackenzie E, Li Y, et al. Translating research into practice: is evidence-based medicine being practiced in military-relevant orthopedic trauma? Mil Med. 2015 Apr;180(4):445-53. doi: 10.7205/MILMED-D-14-00296. PMID: 25826350. Elliott IS, Sonshine DB, Akhavan S, Slade Shantz A, Caldwell A, Slade Shantz J, et al. What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews. Clin Orthop Relat Res. 2015 Jun;473(6):2120-30. doi: 10.1007/s11999-015-4254-5. Epub 2015 Mar 21. PMID: 25795030; PMCID:PMC4419000. Tchetchik A, Grinstein A, Manes E, Shapira D, Durst R. From research to practice: Which research strategy contributes more to clinical excellence? Comparing high-volume versus high-quality biomedical research. PLoS One. 2015 Jun 24;10(6):e0129259. doi: 10.1371/journal.pone.0129259. PMID: 26107296; PMCID: PMC4480880. Chang LY, Tsai KS, Peng JK, Chen CH, Lin GT, Lin CH, et al. The development of Taiwan Fracture Liaison Service network. Osteoporos Sarcopenia. 2018 Jun;4(2):47-52. doi: 10.1016/j.afos.2018.06.001. Epub 2018 Jun 7. PMID: 30775542; PMCID: PMC6362955. Barton DW, Piple AS, Smith CT, Moskal SA, Carmouche JJ. The clinical impact of fracture liaison services: A systematic review. Geriatr Orthop Surg Rehabil. 2021 Jan 11;12:2151459320979978. doi: 10.1177/2151459320979978. PMID: 33489430; PMCID: PMC7809296

Effects of a transsphenoidal surgery quality improvement program on patient outcomes and hospital financial performance

2021 ◽  
pp. 1-10
Author(s):  
Christina E. Sarris ◽  
Scott T. Brigeman ◽  
Estelle Doris ◽  
Maggie Bobrowitz ◽  
Thomas Rowe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Financial Performance ◽  
Patient Care ◽  
Patient Outcomes ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Care Pathways ◽  
Improvement Program ◽  
Hospital Financial Performance ◽  
Improve Patient

OBJECTIVE A comprehensive quality improvement (QI) program aimed at all aspects of patient care after pituitary surgery was initiated at a single center. This initiative was guided by standard quality principles to improve patient outcomes and optimize healthcare value. The programmatic goal was to discharge most elective patients within 1 day after surgery, improve patient safety, and limit unplanned readmissions. The program is described, and its effect on patient outcomes and hospital financial performance over a 5-year period are investigated. METHODS Details of the patient care pathway are presented. Foundational elements of the QI program include evidence-based care pathways (e.g., for hyponatremia and pain), an in-house research program designed to fortify care pathways, patient education, expectation setting, multidisciplinary team care, standard order sets, high-touch postdischarge care, outcomes auditing, and a patient navigator, among other elements. Length of stay (LOS), outcome variability, 30-day unplanned readmissions, and hospital financial performance were identified as surrogate endpoints for healthcare value for the surgical epoch. To assess the effect of these protocols, all patients undergoing elective transsphenoidal surgery for pituitary tumors and Rathke’s cleft cysts between January 2015 and December 2019 were reviewed. RESULTS A total of 609 adult patients who underwent elective surgery by experienced pituitary surgeons were identified. Patient demographics, comorbidities, and payer mix did not change significantly over the study period (p ≥ 0.10). The mean LOS was significantly shorter in 2019 versus 2015 (1.6 ± 1.0 vs 2.9 ± 2.2 midnights, p < 0.001). The percentage of patients discharged after 1 midnight was significantly higher in 2019 versus 2015 (75.4% vs 15.6%, p < 0.001). The 30-day unplanned hospital readmission rate decreased to 2.8% in 2019 from 8.3% in 2015. Per-patient hospital profit increased 71.3% ($10,613 ± $19,321 in 2015; $18,180 ± $21,930 in 2019), and the contribution margin increased 42.3% ($18,925 ± $19,236 in 2015; $26,939 ± $22,057 in 2019), while costs increased by only 3.4% ($18,829 ± $6611 in 2015; $19,469 ± $4291 in 2019). CONCLUSIONS After implementation of a comprehensive pituitary surgery QI program, patient outcomes significantly improved, outcome variability decreased, and hospital financial performance was enhanced. Future studies designed to evaluate disease remission, patient satisfaction, and how the surgeon learning curve may synergize with other quality efforts may provide additional context.

The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes

2000 ◽  
Vol 30 (1) ◽  
pp. 195-204 ◽  
Author(s):  
TERESA TATTAN ◽  
NICHOLAS TARRIER
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Positive Relationship ◽  
Expressed Emotion ◽  
Case Manager ◽  
Case Managers ◽  
Informal Carers ◽  
The Relationship

Background. Expressed emotion (EE) measured from relatives and informal carers has been consistently demonstrated to be associated with clinical outcome in schizophrenic patients. There have also been published studies that have investigated EE in professional carers that have suggested that the quality of the relationship between staff and patient may also be associated with patient outcomes. A large controlled trial of the effectiveness of different intensities of case management provided the opportunity to assess the association between the EE of case managers, including the quality of the relationship they had with patients under their care, and later clinical outcomes.Method. This was a prospective naturalistic study of EE present in a case manager–patient dyad and subsequent patient outcomes. EE was assessed from the Five Minute Speech Sample (FMSS) at least 3 months after the case manager became responsible for the patient's care and a range of clinical outcomes were assessed 6 to 9 months later. Assessment of clinical outcomes was made independent and blind of the EE ratings.Results. High EE ratings were significantly associated with individual case managers and not to symptom or illness factors. High EE was not associated with later clinical outcome, however, the positive relationship between case manager and patient was. The absence of a positive relationship was significantly associated with poorer outcomes.Conclusions. In spite of very low face-to-face contact between case managers and patients, compared with the amount of contact patients have with their informal carers and family, aspects of staff attitudes and behaviour did influence clinical outcome. There are potential implications of these results for staff training and clinical practice.

scholarly journals AIMS: A Care Coordination Model to Improve Patient Health Outcomes

2016 ◽  
Vol 41 (3) ◽  
pp. 191-195 ◽  
Author(s):  
Victoria M. Rizzo ◽  
Jeannine M. Rowe ◽  
Gayle Shier Kricke ◽  
Kate Krajci ◽  
Robyn Golden
Keyword(s):  
Health Outcomes ◽  
Care Coordination ◽  
Coordination Model ◽  
Patient Health ◽  
Improve Patient

scholarly journals Artificial Intelligence, Heuristic Biases, and the Optimization of Health Outcomes: Cautionary Optimism

2021 ◽  
Vol 10 (22) ◽  
pp. 5284
Author(s):  
Michael Feehan ◽  
Leah A. Owen ◽  
Ian M. McKinnon ◽  
Margaret M. DeAngelis
Keyword(s):  
Artificial Intelligence ◽  
Health Outcomes ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Health Inequity ◽  
Great Promise ◽  
Patient Health ◽  
Improve Patient ◽  
Regulatory Landscapes

The use of artificial intelligence (AI) and machine learning (ML) in clinical care offers great promise to improve patient health outcomes and reduce health inequity across patient populations. However, inherent biases in these applications, and the subsequent potential risk of harm can limit current use. Multi-modal workflows designed to minimize these limitations in the development, implementation, and evaluation of ML systems in real-world settings are needed to improve efficacy while reducing bias and the risk of potential harms. Comprehensive consideration of rapidly evolving AI technologies and the inherent risks of bias, the expanding volume and nature of data sources, and the evolving regulatory landscapes, can contribute meaningfully to the development of AI-enhanced clinical decision making and the reduction in health inequity.

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