Referral Processes and Dispositions in a Multidisciplinary Team for Older Adults With Cognitive Vulnerability

Multidisciplinary team care for community-dwelling older adults with multiple chronic conditions has proven value. Older adults receiving team care experience better outcomes than by solo practitioners alone, and teams are being established as outgrowths of primary care and other clinical settings. Yet little is known about the inner workings of multidisciplinary teams, both in terms of how referral patterns among team members are established and the extent to which older adults and their families accept referrals from team leaders to other clinical disciplines within teams. In this presentation, we provide details about referral patterns and rates of acceptance by study participants in an ongoing clinical trial testing a multidisciplinary team designed to provide care management to older adults (age >65) with cognitive vulnerability due to dementia, depression, and/or delirium (3D Team). Nurse practitioners lead the 3D Team, conduct in-home clinical assessments and make referrals to other team members based on study protocols specifying participants’ eligibility for each 3D Team member. Results are based on the first 209 older adults randomized to the 3D Team. Pharmacist: all 209 members accepted having their medications reviewed and reconciled. Registered Dietician: of 134 referrals, 52 (38.8%) accepted. Occupational Therapist, of 117 referrals, 65 (55.6%) accepted. Physical Therapist: of 109 referrals, 92 (84.4%) accepted. Community Health Educator: of 106 referrals, 101 (95%) accepted. LCSW for depression-related problem solving therapy: of 76 referrals, 55 (72.4%) accepted. Criteria for referrals and interpretations of variations in referral acceptance rates by older adults and their families will be discussed.

The effects in assistance indicators of changes on a nursing team

Introduction: This article discusses the path of healthcare associated infections (HAI) indicators in the intensive care unit (ICU) of a public teaching hospital in Belo Horizonte, Minas Gerais, Brazil, after certain change in its nursing staff: pair of nursing caregivers. The model of a pair of caregivers consists in assigning one nurse and one nursing technician for every three patients. The indicators analyzed were infection related to central venous catheters (CVCs), the risk of HAI, turnover, and absenteeism. Objective: The objective of this paper is to understand the impact of the restructuring of the nursing staff in Human Resources and on the rate of infection in the ICU. Methods: As for methods, it is a qualitative and descriptive research carried out as a case study. Results: The results have shown that the risk of HAIs significantly increased after the change in staffing, but the density of vascular access infection associated with CVCs was drastically reduced. The results of turnover of nursing technics decreased and the turnover of nurses increased while the absenteeism of the nursing team decreased after the change. The interviews revealed that there was a gain at the care due to the change. Conclusion: As a conclusion, the results of the study have shown that the proposed nursing model caused a care gain, once the interviews exposed that and indicator directly related to nursing team care (infection associated with CVCs) decreased.

Cost of Cleft Team Care at an Academic Children’s Hospital

Background The financial burden of cleft-craniofacial team care is substantial, and high costs can hinder successful completion of team care. Solution Collaboration with multiple stakeholders including providers, insurers, and patient guardians, as well as hospital administrators, is critical to increase patient retention and improve final clinical outcomes. What We Do That is New At our cleft and craniofacial center, charges for a team care visit fall into one of three categories—hospital fees, professional fees, or external fees. There are four types of hospital fees depending on (1) whether the patient is new or returning, and (2) whether the patient saw ≤4 or ≥5 providers. To further elucidate the financial burden (out-of-pocket costs) directly borne by families of children with cleft lip and/or palate, we conducted a retrospective review of billing records of team care visits made between September 2019 and March 2020. Out-of-pocket costs for a single team care visit (on a commercial insurance plan) ranged from $4 to approximately $1220 and had a median (IQR) of $445 ($118, $749).

Incremental benefit of interdisciplinary care in resource identification in an adolescent and young adult (AYA) oncology care model.

228 Background: Conventional health care models inadequately address the complex needs of adolescents and young adults (AYAs, defined as patients aged 15-39) with cancer, thus necessitating AYA programs. While grounded in the integration of medical and psychosocial care, the best AYA care model has not been identified. We sought to evaluate the comparative impact of one-on-one AYA clinic visits versus interdisciplinary team care on AYA-specific resource identification. Methods: We identified patients seen at the University of Wisconsin (UW) AYA Oncology program between 1/21/2021-5/13/2021. Patients in this program have a one-on-one clinic visit with an AYA physician followed four days later by case presentation at an AYA interdisciplinary team (IDT) meeting. We conducted retrospective chart review to evaluate novel resources identified by the AYA IDT meeting versus those previously identified during the one-on-one AYA clinic visit. Resources identified had to be novel from those already used by or identified for the patient. Results: We identified 32 patients seen by the UW AYA Oncology program. Prior to their AYA clinic visit, patients saw an average of 2.0 AYA-specific services (range 0-6, defined as those services listed in table). As seen in table, an average of 2.8 novel AYA-specific resources were identified for each patient (range 0-5) during the one-on-one AYA clinic visit. Following the AYA IDT meeting, additional novel resources were identified in 100% of patients, with an average of 2.6 additional resources identified per patient (range 1-7). Considering all resources identified by the AYA Oncology program (clinic visit + IDT), an average of 5.4 novel resources were identified per patient (range 2-10). AYA-Specific Resource Identification (n=32). Conclusions: Supporting the importance of dedicated AYA care models, we found that all patients in our study had novel AYA-specific resources identified by the UW AYA Oncology program. Resources identified by the physician-led one-on-one AYA clinic visit were not comprehensive as additional resources were identified for each patient at the AYA IDT meeting only four days later. These objective data support the critical importance of AYA interdisciplinary care as well as the use of an AYA IDT meeting model as a method to include interdisciplinary team care in AYA programs despite possible resource constraints.[Table: see text]

Telemedicine as an Alternative Way to Provide Multidisciplinary Cleft Care During the COVID-19 Pandemic

The current coronavirus pandemic is changing the way healthcare professionals provide services to patients. Healthcare professionals are required to provide quality care while reducing the risk of viral transmission. This pandemic has disrupted the timely multidisciplinary team care for patients with clefts across the globe. Thus, telemedicine has been recognized and accepted by various medical and dental specialists as a viable alternative to face-to-face consultation. In addition, telemedicine incorporating a digital workflow in cleft management will further reduce the risk of viral transmission and enhance the quality of treatment being provided to these patients.

Intrusiveness and Social Media in Mental Health Research: A Reflection. Comment on "Twitter Users’ Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis" (Preprint)

UNSTRUCTURED not applicable

Familial Pfeiffer Syndrome: Variable Manifestations and Role of Multidisciplinary Team Care

Pfeiffer syndrome is one of the autosomal dominant craniofacial syndromes. Classical clinical manifestations are coronal suture synostosis causing brachycephaly, midface retrusion, airway compromise, broad thumbs, and toes. Pfeiffer syndrome type I (classic type) is associated with FGFR1 mutation. However, wide range of clinical manifestations, with and without craniosynostosis, have been reported. Here, we present a family of Pfeiffer syndrome across 3 generations with identical FGFR1: c.755C>G (p.Pro252Arg) mutation. Where the members of the youngest generation have no cranial involvement. Lastly, we propose a guideline management for familial Pfeiffer syndrome management.