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BioMed Research International 2022The aim was to evaluate the association between the professional training of dentists and their outpatient production (OP) of clinical and collective/preventive...
BACKGROUND
The aim was to evaluate the association between the professional training of dentists and their outpatient production (OP) of clinical and collective/preventive procedures and the total number of procedures registered in a health information system.
METHODS
It included all 19,947 primary dental care units participating in the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB 2nd cycle) and the number of clinical procedures (CP), collective/preventive procedures (PP), and total procedures (TP) registered in the ambulatory information system between November 2013 and July 2014 for each participant oral health team. The outcome was being above the national median of procedures. The main variables related to training were the dentists specialising in family health, the level of training, and participation in permanent education. Effect estimates were calculated by multiple logistic regression.
RESULTS
In the final model, controlled by contextual factor work process, family health specialists had higher chances (odds ratio (OR) = 1.13, 95% CI: 1.00; 1.27) of producing above the national median of CP than nonspecialists, OR = 1.06 (0.96; 1.18) for PP and OR = 1.17 (1.08; 1.27) for TP. Dentists taking permanent education had higher chances than those not taking it of producing above the national median for CP, PP, and TT, respectively, with OR = 1.40 (1.20; 1.62), OR = 1.24 (1.09; 1.40), and OR = 1.28 (1.18; 1.39).
CONCLUSION
Training in family health performs more procedures in primary care settings than those without training. However, this OP is influenced by variables related to the municipality and the work process, especially for PP. If the highest production observed is a consequence of training, then public health managers can not only encourage training policies such as permanent education policies to expand the use of services.
Topics: Dentists; Family Health; Humans; Oral Health; Outpatients
PubMed: 35355824
DOI: 10.1155/2022/5365363 -
JAMA Network Open Jul 2021There is widespread concern that clinical notes have grown longer and less informative over the past decade. Addressing these concerns requires a better understanding of...
IMPORTANCE
There is widespread concern that clinical notes have grown longer and less informative over the past decade. Addressing these concerns requires a better understanding of the magnitude, scope, and potential causes of increased note length and redundancy.
OBJECTIVE
To measure changes between 2009 and 2018 in the length and redundancy of outpatient progress notes across multiple medical specialties and investigate how these measures associate with author experience and method of note entry.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study was conducted at Oregon Health & Science University, a large academic medical center. Participants included clinicians and staff who wrote outpatient progress notes between 2009 and 2018 for a random sample of 200 000 patients. Statistical analysis was performed from March to August 2020.
EXPOSURES
Use of a comprehensive electronic health record to document patient care.
MAIN OUTCOMES AND MEASURES
Note length, note redundancy (ie, the proportion of text identical to the patient's last note), and percentage of templated, copied, or directly typed note text.
RESULTS
A total of 2 704 800 notes written by 6228 primary authors across 46 specialties were included in this study. Median note length increased 60.1% (99% CI, 46.7%-75.2%) from a median of 401 words (interquartile range [IQR], 225-660 words) in 2009 to 642 words (IQR, 399-1007 words) in 2018. Median note redundancy increased 10.9 percentage points (99% CI, 7.5-14.3 percentage points) from 47.9% in 2009 to 58.8% in 2018. Notes written in 2018 had a mean value of just 29.4% (99% CI, 28.2%-30.7%) directly typed text with the remaining 70.6% of text being templated or copied. Mixed-effect linear models found that notes with higher proportions of templated or copied text were significantly longer and more redundant (eg, in the 2-year model, each 1% increase in the proportion of copied or templated note text was associated with 1.5% [95% CI, 1.5%-1.5%] and 1.6% [95% CI, 1.6%-1.6%] increases in note length, respectively). Residents and fellows also wrote significantly (26.3% [95% CI, 25.8%-26.7%]) longer notes than more senior authors, as did more recent hires (1.8% for each year later [95% CI, 1.3%-2.4%]).
CONCLUSIONS AND RELEVANCE
In this study, outpatient progress notes grew longer and more redundant over time, potentially limiting their use in patient care. Interventions aimed at reducing outpatient progress note length and redundancy may need to simultaneously address multiple factors such as note template design and training for both new and established clinicians.
Topics: Academic Medical Centers; Cross-Sectional Studies; Documentation; Electronic Health Records; Humans; Oregon; Outpatients; Time Factors
PubMed: 34279650
DOI: 10.1001/jamanetworkopen.2021.15334 -
BMJ Open Quality Mar 2022Hip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible...
BACKGROUND
Hip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients.
METHODS
This was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented.
RESULTS
After implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days.
CONCLUSION
Our study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.
Topics: Arthroplasty, Replacement, Hip; COVID-19; Critical Pathways; Humans; Outpatients; Pandemics; Quality Improvement
PubMed: 35318244
DOI: 10.1136/bmjoq-2021-001698 -
Journal of Medical Internet Research Apr 2021The decision to use patient portals can be influenced by multiple factors, including individuals' perceptions of the tool, which are based on both their personal skills... (Observational Study)
Observational Study
BACKGROUND
The decision to use patient portals can be influenced by multiple factors, including individuals' perceptions of the tool, which are based on both their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users in particular may have confidence in their ability to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of other portals has not been studied.
OBJECTIVE
This study aims to understand how patients' use of an inpatient portal is influenced by outpatient portal use.
METHODS
This study included patients from an academic medical center who were provided access to an inpatient portal during their hospital stays between 2016 and 2018 (N=1571). We analyzed inpatient portal log files to investigate how inpatient portal use varied by using 3 categories of outpatient portal users: prior users, new users, and nonusers.
RESULTS
Compared with prior users (695/1571, 44.24%) of an outpatient portal, new users (214/1571, 13.62%) had higher use of a select set of inpatient portal functions (messaging function: incidence rate ratio [IRR] 1.33, 95% CI 1.06-1.67; function that provides access to the outpatient portal through the inpatient portal: IRR 1.34, 95% CI 1.13-1.58). Nonusers (662/1571, 42.14%), compared with prior users, had lower overall inpatient portal use (all active functions: IRR 0.68, 95% CI 0.60-0.78) and lower use of specific functions, which included the function to review vitals and laboratory results (IRR 0.51, 95% CI 0.36-0.73) and the function to access the outpatient portal (IRR 0.53, 95% CI 0.45-0.62). In comparison with prior users, nonusers also had lower odds of being comprehensive users (defined as using 8 or more unique portal functions; odds ratio [OR] 0.57, 95% CI 0.45-0.73) or composite users (defined as comprehensive users who initiated a 75th or greater percentile of portal sessions) of the inpatient portal (OR 0.42, 95% CI 0.29-0.60).
CONCLUSIONS
Patients' use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings.
Topics: Academic Medical Centers; Hospitalization; Humans; Inpatients; Outpatients; Patient Portals
PubMed: 33929328
DOI: 10.2196/23866 -
Human Resources For Health Jul 2021To investigate opportunities for task shifting to decongest an outpatient neurology clinic in Zambia by describing current patient flow through the clinic and potential...
OBJECTIVE
To investigate opportunities for task shifting to decongest an outpatient neurology clinic in Zambia by describing current patient flow through the clinic and potential nodes for intervention using process mapping.
BACKGROUND
Zambia has a population of approximately 18 million people with 4 full-time adult neurologists, as of 2018, who all practice at the University Teaching Hospital (UTH), the main tertiary care center in the country. As a result of this provider-to-patient ratio, the outpatient neurology clinic is overcrowded and overbooked. Task-shifting programs have shown to improve efficiency, access and quality of care through the use of less specialized healthcare workers in low- and middle-income countries (LMIC).
METHODS
We evaluated patient flow in the UTH neurology outpatient clinic through the development and analysis of a process map. The characteristics of the clinic population between 2014 and 2018 were retrospectively reviewed from the clinic register. Between July and August 2018, we prospectively collected appointment lag times and time each patient spent waiting at various points in the clinic process. We conducted interviews with clinic staff and neurologists to generate a detailed process map of current pathways to care within the clinic. We then devised task-shifting strategies to help reduce patient wait times based on the overview of clinic process mapping and patient demographics.
RESULTS
From 2014 to 2018, there were 4701 outpatients seen in the neurology clinic. The most common neurological diagnoses were epilepsy (39.2%), headache (21.5%) and cerebrovascular disease (16.7%). During prospective data collection, patients waited an average of 57.8 (SD 73.4) days to be seen by a neurologist. The average wait time from arrival in the clinic to departure was 4.0 (SD 2.5) h. The process map and interviews with clinic staff revealed long waiting times due to a paucity of providers. Nurses and clerks represent an influential stakeholder group, but are not actively involved in any activity to reduce wait times. A large proportion of follow-up patients were stable and seen solely to obtain medication refills.
CONCLUSIONS
Epilepsy, headache, and stroke make up the largest percentage of outpatient neurological illness in Zambia. Targeting stable patients in these diagnostic categories for a task-shifting intervention may lead to substantially decreased patient wait times. Potential interventions include shifting clinical follow-ups and medication refills to less specialized healthcare workers.
Topics: Adult; Ambulatory Care; Ambulatory Care Facilities; Humans; Outpatients; Retrospective Studies; Zambia
PubMed: 34271924
DOI: 10.1186/s12960-021-00619-7 -
Current Treatment Options in Oncology Jan 2023The specialty of palliative care has evolved over time to provide symptom management, psychosocial support, and care planning for patients with cancer throughout the... (Review)
Review
The specialty of palliative care has evolved over time to provide symptom management, psychosocial support, and care planning for patients with cancer throughout the disease continuum and in multiple care settings. This review examines the delivery and impact of palliative care in the outpatient, inpatient, and community-based settings. The article will discuss how these 3 palliative care settings can work together to optimize patient outcomes under a unifying model of palliative care "anywhere, anytime" and how to prioritize palliative care services when resources are limited. Many patients with advanced cancer receive care from each of the 3 branches of palliative care-outpatient, inpatient, and community-based settings-at some point along their disease trajectory. Early on, outpatient clinics provide longitudinal supportive care concurrent with active disease-modifying treatments. Telemedicine appointments can serve patients remotely to minimize their need to travel. When patients experience functional decline, community-based palliative care services can provide support and monitoring for patients at home. When patients develop acute symptomatic complications requiring admission, inpatient care consultation teams are essential for symptom management and goals-of-care discussions. For patients in severe distress, receiving care in a palliative care unit that provides intensive symptom control and facilitates complex discharge planning is ideal. Under a unifying model of palliative care designed to offer care "anywhere, anytime," the 3 branches of palliative care could work in unison to support each other, minimize gaps in care, and optimize patient outcomes.
Topics: Humans; Palliative Care; Neoplasms; Inpatients; Outpatients; Quality of Life
PubMed: 36576706
DOI: 10.1007/s11864-022-01044-1 -
Journal of Managed Care & Specialty... Aug 2022Ms Beinfeld and Nahn and Drs Whittington, Mohammed, and Pearson report grants from Arnold Ventures, Kaiser Foundation Health Plan Inc., The Patrick and Catherine Weldon...
Ms Beinfeld and Nahn and Drs Whittington, Mohammed, and Pearson report grants from Arnold Ventures, Kaiser Foundation Health Plan Inc., The Patrick and Catherine Weldon Donaghue Medical Research Foundation, Blue Cross Blue Shield of Massachusetts, and The Commonwealth Foundation, during the conduct of the study; and other from America's Health Insurance Plans, Anthem, AbbVie, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Cambia Health Services, CVS, Editas, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, Health Partners, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Premera, Prime Therapeutics, Regeneron, Sanofi, United Healthcare, HealthFirst, Pfizer, Boehringer-Ingelheim, uniQure, Humana, Sun Life, and Envolve Pharmacy Solutions, outside the submitted work. Dr Yeung received a contract from ICER to be an evidence author for COVID-19 outpatient treatments.
Topics: COVID-19; Cost-Benefit Analysis; Humans; Massachusetts; Outpatients; Treatment Outcome
PubMed: 35876296
DOI: 10.18553/jmcp.2022.28.8.903 -
BMC Health Services Research Aug 2023Focusing on patients' perceived values is essential for patient-centered health care. Only by identifying the patient's preferred values can we better meet their needs...
BACKGROUND
Focusing on patients' perceived values is essential for patient-centered health care. Only by identifying the patient's preferred values can we better meet their needs and provide them with valuable medical services. This study aimed to construct and validate a research model to obtain an overall quantification of patient value during outpatient encounters.
METHODS
The development of the research model was based on the reviewed literature, and an initial theoretical framework was formed by an expert panel discussion. A scale questionnaire for all the items was adapted from previous research related to patient value, verified using a presurvey, and thus used for data collection for this study. The structural equation model was used to determine and evaluate the research model of the values patients perceived during outpatient encounters.
RESULTS
572 eligible respondents who completed outpatient visits from a typical public hospital in China participated in this study from November 2020 to February 2021. We constructed the patient perceived value (PPV) model to identify core values, which includes eight dimensions and 29 items in terms of functional value (installation, efficiency, price, service quality), emotional value (interactive, control), and social value (accessibility, image) from two subgroups of patient value outside and in the outpatient visit process. Cronbach's alpha for the whole model was 0.950. The confirmatory factor analysis showed that the PPV model fits well, with a correlation of 0.83 between the two subgroups.
CONCLUSION
It is essential to recognize the values based on patients' perceptions and experiences throughout the entire visit process. Our findings offer targeted insights for healthcare administrators, enabling them to holistically optimize outpatient service processes and continually enhance the quality of outpatient medical services from the patient's perspective.
Topics: Humans; Outpatients; Hospitals, Public; Ambulatory Care; Empirical Research; China; Patient Satisfaction; Surveys and Questionnaires
PubMed: 37568157
DOI: 10.1186/s12913-023-09817-6 -
Annals of Internal Medicine May 2023
Topics: Humans; COVID-19; Outpatients; Ambulatory Care; SARS-CoV-2
PubMed: 37068278
DOI: 10.7326/L23-0099 -
BMJ Open Quality Mar 2021Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of...
Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of attending hospital OPAs due to transport difficulties, cost, poor health, caring and work responsibilities. Digital solutions may help ameliorate these challenges. This project aimed to implement codesigned outpatient video consultations across National Health Service (NHS) Highland using system-wide quality improvement approaches to implementation, involving patients, carers, clinical and non-clinical staff, national and local strategic leads. System mapping; an intensive codesign process involving extensive stakeholder engagement and real-time testing; Plan, Do, Study, Act cycles; and collection of clinician and patient feedback were used to optimise the service. Standardised processes were developed and implemented, which made video consulting easy to use for patients, embedded video into routine health service systems for clinicians and non-clinical staff, and automated much of the administrative burden. All clinicians and staff are using the system and both groups identified benefits in terms of travel time and costs saved. Transferable lessons for other services are identified, providing a practical blueprint for others to adapt and use in their own contexts to help implement and sustain video consultation services now and in the future.
Topics: Appointments and Schedules; Humans; Outpatients; Quality Improvement; Referral and Consultation; State Medicine
PubMed: 33674346
DOI: 10.1136/bmjoq-2020-001259