-
Scientific Reports Jun 2024Fair allocation of funding in multi-centre clinical studies is challenging. Models commonly used in Germany - the case fees ("fixed-rate model", FRM) and up-front...
Fair allocation of funding in multi-centre clinical studies is challenging. Models commonly used in Germany - the case fees ("fixed-rate model", FRM) and up-front staffing and consumables ("up-front allocation model", UFAM) lack transparency and fail to suitably accommodate variations in centre performance. We developed a performance-based reimbursement model (PBRM) with automated calculation of conducted activities and applied it to the cohorts of the National Pandemic Cohort Network (NAPKON) within the Network of University Medicine (NUM). The study protocol activities, which were derived from data management systems, underwent validation through standardized quality checks by multiple stakeholders. The PBRM output (first funding period) was compared among centres and cohorts, and the cost-efficiency of the models was evaluated. Cases per centre varied from one to 164. The mean case reimbursement differed among the cohorts (1173.21€ [95% CI 645.68-1700.73] to 3863.43€ [95% CI 1468.89-6257.96]) and centres and mostly fell short of the expected amount. Model comparisons revealed higher cost-efficiency of the PBRM compared to FRM and UFAM, especially for low recruitment outliers. In conclusion, we have developed a reimbursement model that is transparent, accurate, and flexible. In multi-centre collaborations where heterogeneity between centres is expected, a PBRM could be used as a model to address performance discrepancies.Trial registration: https://clinicaltrials.gov/ct2/show/NCT04768998 ; https://clinicaltrials.gov/ct2/show/NCT04747366 ; https://clinicaltrials.gov/ct2/show/NCT04679584 .
Topics: Humans; Germany; Cost-Benefit Analysis; Reimbursement Mechanisms; Cohort Studies; COVID-19
PubMed: 38871878
DOI: 10.1038/s41598-024-63945-5 -
Scientific Reports Jun 2024National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative...
National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.
Topics: Humans; Colorectal Neoplasms; Surgeons; Colonoscopy; Gastroenterologists; Canada; Male; Female; Attitude of Health Personnel; Practice Guidelines as Topic; Middle Aged
PubMed: 38849393
DOI: 10.1038/s41598-024-63753-x -
Journal of Cheminformatics May 2024Selecting greener solvents during experiment design is imperative for greener chemistry. While many solvent selection guides are currently used in the pharmaceutical...
Selecting greener solvents during experiment design is imperative for greener chemistry. While many solvent selection guides are currently used in the pharmaceutical industry, these are often paper-based guides which can make it difficult to identify and compare specific solvents. This work presents a stand-alone version of the solvent flashcards that were developed as part of the AI4Green electronic laboratory notebook. The functionality is an intuitive and interactive interface for the visualisation of data from CHEM21, a pharmaceutical solvent selection guide that categorises solvents according to "greenness". This open-source software is written in Python, JavaScript, HTML and CSS and allows users to directly contrast and compare specific solvents by generating colour-coded flashcards. It can be installed locally using pip, or alternatively the source code is available on GitHub: https://github.com/AI4Green/solvent_flashcards . The documentation can also be found on GitHub or on the corresponding Python Package Index webpage: https://pypi.org/project/solvent-guide/ . SCIENTIFIC CONTRIBUTION: This simple and easy-to-use digital tool provides a visualisation of solvent greenness data through a novel intuitive interface and encourages green chemistry. It offers numerous advantages over traditional solvent selection guides, allowing users to directly customise the solvent list and generate side-by-side comparisons of only the most important solvents. The release as a standalone package will maximise the benefit of this software.
PubMed: 38807181
DOI: 10.1186/s13321-024-00854-9 -
The Utility of Dot Phrases and SmartPhrases in Improving Physician Documentation of Interpreter Use.The Western Journal of Emergency... May 2024Patients with limited English proficiency (LEP) experience significant healthcare disparities. Clinicians are responsible for using and documenting their use of...
BACKGROUND
Patients with limited English proficiency (LEP) experience significant healthcare disparities. Clinicians are responsible for using and documenting their use of certified interpreters for patient encounters when appropriate. However, the data on interpreter use documentation in the emergency department (ED) is limited and variable. We sought to assess the effects of dot phrase and SmartPhrase implementation in an adult ED on the rates of documentation of interpreter use.
METHODS
We conducted an anonymous survey asking emergency clinicians to self-report documentation of interpreter use. We also retrospectively reviewed documentation of interpreter- services use in ED charts at three time points: 1) pre-intervention baseline; 2) post-implementation of a clinician-driven dot phrase shortcut; and 3) post-implementation of a SmartPhrase.
RESULTS
Most emergency clinicians reported using an interpreter "almost always" or "often." Our manual audit revealed that at baseline, interpreter use was documented in 35% of the initial clinician note, 4% of reassessments, and 0% of procedure notes; 52% of discharge instructions were written in the patients' preferred languages. After implementation of the dot phrase and SmartPhrase, respectively, rates of interpreter-use documentation improved to 43% and 97% of initial clinician notes, 9% and 6% of reassessments, and 5% and 35% of procedure notes, with 62% and 64% of discharge instructions written in the patients' preferred languages.
CONCLUSION
There was a discrepancy between reported rates of interpreter use and interpreter-use documentation rates. The latter increased with the implementation of a clinician-driven dot phrase and then a SmartPhrase built into the notes. Ensuring accurate documentation of interpreter use is an impactful step in language equity for LEP patients.
Topics: Humans; Documentation; Translating; Emergency Service, Hospital; Retrospective Studies; Limited English Proficiency; Surveys and Questionnaires; Communication Barriers; Physicians; Healthcare Disparities; Adult
PubMed: 38801040
DOI: 10.5811/westjem.18352 -
Clinical Case Reports Jun 2024We present a case of a single left hemisphere temporal-parietal stroke with subacute global aphasia and severe verbal apraxia and moderate dysphagia. The patient...
We present a case of a single left hemisphere temporal-parietal stroke with subacute global aphasia and severe verbal apraxia and moderate dysphagia. The patient underwent a combined transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) and language stimulation with Virtual Reality Rehabilitation System (VRRS). Patient was treated in a 1-h session, for 5 days a week, for 4 consecutive weeks. After treatment, evident improvements in the comprehension of oral and written language, swallowing abilities, and caregiver burden were detected. Power spectrum analysis of EEG data revealed significant enhancements of , , and waves from baseline to follow-up. These preliminary results seem to confirm the reliability of the tDCS translational application in conjunction with computer-based cognitive treatment for language disorders in a patient with stroke-induced aphasia.
PubMed: 38799514
DOI: 10.1002/ccr3.8928 -
JAMA Network Open May 2024Time on the electronic health record (EHR) is associated with burnout among physicians. Newer virtual scribe models, which enable support from either a real-time or...
IMPORTANCE
Time on the electronic health record (EHR) is associated with burnout among physicians. Newer virtual scribe models, which enable support from either a real-time or asynchronous scribe, have the potential to reduce the burden of the EHR and EHR-related documentation.
OBJECTIVE
To characterize the association of use of virtual scribes with changes in physicians' EHR time and note and order composition and to identify the physician, scribe, and scribe response factors associated with changes in EHR time upon virtual scribe use.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective, pre-post quality improvement study of 144 physicians across specialties who had used a scribe for at least 3 months from January 2020 to September 2022, were affiliated with Brigham and Women's Hospital and Massachusetts General Hospital, and cared for patients in the outpatient setting. Data were analyzed from November 2022 to January 2024.
EXPOSURE
Use of either a real-time or asynchronous virtual scribe.
MAIN OUTCOMES
Total EHR time, time on notes, and pajama time (5:30 pm to 7:00 am on weekdays and nonscheduled weekends and holidays), all per appointment; proportion of the note written by the physician and team contribution to orders.
RESULTS
The main study sample included 144 unique physicians who had used a virtual scribe for at least 3 months in 152 unique scribe participation episodes (134 [88.2%] had used an asynchronous scribe service). Nearly two-thirds of the physicians (91 physicians [63.2%]) were female and more than half (86 physicians [59.7%]) were in primary care specialties. Use of a virtual scribe was associated with significant decreases in total EHR time per appointment (mean [SD] of 5.6 [16.4] minutes; P < .001) in the 3 months after vs the 3 months prior to scribe use. Scribe use was also associated with significant decreases in note time per appointment and pajama time per appointment (mean [SD] of 1.3 [3.3] minutes; P < .001 and 1.1 [4.0] minutes; P = .004). In a multivariable linear regression model, the following factors were associated with significant decreases in total EHR time per appointment with a scribe use at 3 months: practicing in a medical specialty (-7.8; 95% CI, -13.4 to -2.2 minutes), greater baseline EHR time per appointment (-0.3; 95% CI, -0.4 to -0.2 minutes per additional minute of baseline EHR time), and decrease in the percentage of the note contributed by the physician (-9.1; 95% CI, -17.3 to -0.8 minutes for every percentage point decrease).
CONCLUSIONS AND RELEVANCE
In 2 academic medical centers, use of virtual scribes was associated with significant decreases in total EHR time, time spent on notes, and pajama time, all per appointment. Virtual scribes may be particularly effective among medical specialists and those physicians with greater baseline EHR time.
Topics: Electronic Health Records; Humans; Retrospective Studies; Female; Male; Physicians; Documentation; Time Factors; Quality Improvement; Adult; Middle Aged
PubMed: 38787556
DOI: 10.1001/jamanetworkopen.2024.13140 -
PloS One 2024This study investigates the interplay between strategic goals and calculative practices, specifically Customer Profitability Analysis (CPA). Drawing on practice-based...
PURPOSE
This study investigates the interplay between strategic goals and calculative practices, specifically Customer Profitability Analysis (CPA). Drawing on practice-based theories, the research aims to understand how managers strategize with CPA, including the balancing of financial and strategic objectives and the interplay of institutionalized practices with individual practitioners' actions.
DESIGN
The study uses a qualitative, revelatory, and exploratory case study approach at the sub-organizational level in a manufacturing company. The researchers compare CPA practices across six departments, guided by a phenomenological research design. Data collection methods include informal conversations, qualitative observations, written documentation, numerical evidence from the accounting system, and interviews.
FINDINGS
The study offers four novel findings to the field. First, it highlights how managers employ procedural and interactive strategizing to reframe CPA practices. The sophistication of CPA practices increases with unevenly distributed customer volume, high customer-specific, controllable overhead, customer-to-customer interaction, and service complexity. Conversely, the sophistication of cost-focused CPA practices tends to decrease with diverse strategic goals. Additionally, CPA become more effective through the utilization of non-financial information, employee empowerment, localization, and strategic alignment. Second, CPA can be adapted through integrative strategizing where managers avoid using it as a financial benchmark for strategic initiatives. Third, accountants actively seek intermediary roles to incorporate arguments from strategy and marketing to balance strategic objectives-contrary to their portrayal as myopic guardians of profitability. Fourth, the localization of CPA practices to front-line employees compensates for a lack of sophisticated CPA practices.
FUTURE RESEARCH
Future research should, investigate the adaptation of calculative practices in different cultures, and industries. Exploring additional contextual factors such as uncertainty, management characteristics, and linguistic framing of practices would be beneficial. Examining the interactions in utilizing CPA practices between front-line staff and customers would shed light on their effectiveness. Lastly, investigating the role of consultants in diffusing such practices would offer valuable perspectives.
Topics: Humans; Consumer Behavior; Decision Making; Costs and Cost Analysis
PubMed: 38776306
DOI: 10.1371/journal.pone.0296974 -
Journal of Multidisciplinary Healthcare 2024The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to...
Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients.
PURPOSE
The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care.
PATIENTS AND METHODS
We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented.
RESULTS
The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the . The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints.
CONCLUSION
The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.
PubMed: 38736534
DOI: 10.2147/JMDH.S455281 -
Journal of Public Health Research Apr 2024(SRP) provides health care services through Ayurveda, an initiative of the Government of India that aims to survey and create alertness of essential health appliances...
(SRP) provides health care services through Ayurveda, an initiative of the Government of India that aims to survey and create alertness of essential health appliances to ameliorate society from its grassroots level. The present study aimed to survey the prevailing health standards of residents in certain districts of India and to record the prevalence of diseases among them according to their living conditions, food habits, lifestyle, education, occupation and other socio-economic status. Data was collected through a community-based cross-sectional survey conducted from April 2018 to March 2019 in 22 Districts of 19 states in India. A stratified multi-stage sampling design was adopted for the survey. Documentation of demographic profile, food habits, lifestyle, hygiene status, and existing health conditions was assessed. A pre-designed semi-structured questionnaire was used for the collection of the data. Before initiating the programme, written consent was obtained. In this study, from 162 selected villages/colonies/areas, a total of 562,913 population and 81,651 households were surveyed. Sixty-nine thousand three hundred nineteen patients were cared for various ailments through health camps. The study found that the most prevalent disease in the concerned population was '' (Osteo-arthritis), that is, 43.0%, followed by '' (Debility), that is, 11.7%. The study includes insightful analyses of comprehensive demographic and health indicators classified by various socio-economic categories. The collected data regarding the prevalence of diseases with their sociodemographic correlations may provide a better understanding of the locality and thus may help in all future health endeavours.
PubMed: 38655097
DOI: 10.1177/22799036241243272 -
Saudi Journal of Anaesthesia 2024This case report highlights the use of an integrated Dual Recording System (iDRS) to document and analyze airway management. The iDRS combines video laryngoscopy and a...
This case report highlights the use of an integrated Dual Recording System (iDRS) to document and analyze airway management. The iDRS combines video laryngoscopy and a wide-angle camera to capture dual-view recordings of the larynx and operating room during airway procedures. We utilized this system in a 5-month-old boy with a difficult airway who underwent pulmonary artery banding under general anesthesia. Retrospective video analysis showed discrepancies between written information and iDRS video findings, including differences in the desaturation cause, description of airway procedures, and effectiveness of interventions. Video analysis facilitated a revised airway management strategy for subsequent anesthesia for cardiac catheterization. This emphasizes the value of the comprehensive information provided by iDRS recordings that facilitate effective post-procedure analysis and better planning of airway management strategies for subsequent care, which ultimately improves clinical decision-making and patient care.
PubMed: 38654848
DOI: 10.4103/sja.sja_841_23