Friday, December 11, 2009
Friday, December 4, 2009
Tuesday, December 1, 2009
How to define and measure concordance between patients’ preferences and medical treatments: A systematic review of approaches and recommendations for standardization
How to define and measure concordance between patients’ preferences and medical treatments: A systematic review of approaches and recommendations for standardization: "Abstract: Objective: The purpose is to systematically review the methods used to calculate the association between patients’ preferences and treatment choices and to present a set of recommendations for definition and measurement of this concept.Methods: A systematic review of the literature from 1967 to 2007 identified articles that reported a relationship between patients’ preferences and their treatment choices. Potential citations were identified from electronic databases, the Cochrane Collaborative review, and identified experts. Relevant articles were abstracted by two reviewers independently using standard forms.Results: The search identified 3114 unique citations, the full text of 180 articles was examined, and 49 articles were included. These 49 studies used a variety of definitions of preferences and choices, and calculated concordance in different ways. Half of the studies tied their method to a theoretical framework. There were problems with many of the studies that limit the ability to generalize or make comparisons across studies.Conclusion: There is no consistent method for defining or calculating the match between patients’ preferences and treatment choices. There is a need for more clarity in the definition and reporting of this type of concordance in measures of decision quality.Practice Implications: The match between an informed patient's preferences and treatment choices is a key component of patient-centered care. Valid and reliable measures of the level of concordance are needed."
Thursday, November 26, 2009
Wednesday, November 4, 2009
Saturday, October 24, 2009
Wednesday, October 21, 2009
Thursday, October 15, 2009
Tuesday, October 13, 2009
Wednesday, October 7, 2009
Patient factors in the implementation of decision aids in general practice: a qualitative study
Patient factors in the implementation of decision aids in general practice: a qualitative study: "Background Decision aids (DAs) have been developed to help patients make treatment decisions. Research shows that they are effective in increasing patients' knowledge of treatment options without raising anxiety or conflict. However, they have not been routinely adopted for use in general practice in the UK and there are few reports addressing strategies to introduce them.Objective To examine patients' views about a variety of DAs for different conditions (heart disease, osteoporosis, osteoarthritis and breast cancer) in order to inform a strategy to introduce them into general practice.Setting and participants General practice patients over the age of 18 years being or having been treated for one of the conditions above.Methods Qualitative study involving 12 focus groups with 77 patients evaluating decision aids relevant to their conditions. A semi-structured interview guide was used to generate discussions about the applicability of the DAs in routine general practice.Results Patients welcomed DAs for their educational and informational content. Reactions to the DAs were influenced by patients' own personal desires for involvement. The main concerns were that the use of DAs would potentially shift the onus of decision making responsibility on to the patient and about the practical challenges to implementation.Conclusions Clinicians will need to make explicit to patients that DAs are an adjunct to routine care and not a replacement, and therefore do not represent a derogation of responsibility. DAs need to be used as an integral part of the communication and support process for patients who want them."
Tuesday, October 6, 2009
Monday, October 5, 2009
Friday, October 2, 2009
Thursday, October 1, 2009
Monday, September 28, 2009
Eight Minutes To Change Their Lives: Leveraging Health 2.0 in Practice
Eight Minutes To Change Their Lives: Leveraging Health 2.0 in Practice
Health 2.0 technology is all about patient empowerment and giving patients the information they need to make an impact on their own healthcare. While my colleagues and I have been writing about Health 2.0 tech for some time, it was with great interest that we held a recent conversation with Dr. Jeff Livingston, who is leveraging it to educate and empower the patients he serves in his busy Irving, Texas, MacArthur obstetrics and gynecology practice. As Dr. Livingston points out, he and his partners frequently have only eight minutes to spend with their patients, important decisions need to be made, and this short time can have a life-changing effect on outcomes. Using technology has helped him to maximize the impact and role he plays in this short time with his patients.
Best Practices: Eight Minutes to Change Their Lives (report)(requires registration)
Health 2.0 technology is all about patient empowerment and giving patients the information they need to make an impact on their own healthcare. While my colleagues and I have been writing about Health 2.0 tech for some time, it was with great interest that we held a recent conversation with Dr. Jeff Livingston, who is leveraging it to educate and empower the patients he serves in his busy Irving, Texas, MacArthur obstetrics and gynecology practice. As Dr. Livingston points out, he and his partners frequently have only eight minutes to spend with their patients, important decisions need to be made, and this short time can have a life-changing effect on outcomes. Using technology has helped him to maximize the impact and role he plays in this short time with his patients.
Best Practices: Eight Minutes to Change Their Lives (report)(requires registration)
Denmark runs telehealth pilots
Denmark runs telehealth pilots
25 Sep 2009
"Denmark has rolled-out two telehealth pilots it now intends to implement nationally over the next three years. One of the pilots, already rolled-out at the Odense University Hospital, involves using a video conferencing service to allow foreign patients who don’t speak Danish to communicate with hospital staff. The service uses a video conferencing system, linked to a call centre with multi-lingual operators, who can translate a persons needs or problems immediately to help them receive a better diagnosis. Claus said “The way we want to deal with the amount of foreign patients that we have difficulty communicating with is by using a video conferencing system and using a centre with interpreters. The method has already been tested in a pilot for the last five months and shown that much better interpretations including professional interpretations have been made.”
October is Patient-Centered Care Awareness Month,
Patient-Centered Care Awareness by Brian Ahier
"October is Patient-Centered Care Awareness Month, but many do not even know what patient-centered care is or how important this philosophy is to health reform. I have written previously on some aspects of patient-centered care (such as letting a patient see and even make their own chart notes). I suggest you see this post first if you have not read it yet, and especially watch the fun video clip so that you are in the right frame of mind for this discussion. Healthcare has been evolving away from a "disease-centered model" and toward a "patient-centered model." I look forward to the focus on patient-centered care this month."
"October is Patient-Centered Care Awareness Month, but many do not even know what patient-centered care is or how important this philosophy is to health reform. I have written previously on some aspects of patient-centered care (such as letting a patient see and even make their own chart notes). I suggest you see this post first if you have not read it yet, and especially watch the fun video clip so that you are in the right frame of mind for this discussion. Healthcare has been evolving away from a "disease-centered model" and toward a "patient-centered model." I look forward to the focus on patient-centered care this month."
Friday, September 25, 2009
Friday, September 11, 2009
IHI Open School for Health Professions
The IHI Open School for Health Professions is an interprofessional educational community that gives students the skills to become change agents in health care improvement. We’re talking about skills like quality improvement, patient safety, teamwork, leadership, and patient-centered care. Employers are looking for these skills, and patients expect providers to have them. But most schools barely touch on these topics. We’re here to fill that void. Here's what the IHI Open School can offer you:
The IHI Open School — including all of our online tools and resources, and our online courses — is open and free for students of all health care professions. During this limited prototyping phase, we are also making these resources available for free to non-students.
Youtube Channel
- Online courses written by world-renowned faculty. Boost your skills and your resume anywhere you have Internet access.
- A network of students like you. Connect with students from other professions, states, and countries, through our online discussions and face-to-face campus Chapters.
- Case studies, podcasts, videos, featured articles — and a bounty of other online resources.
- IHI Certificates of Completion (coming soon). We will soon offer certificates of completion in quality improvement, patient safety, and other topics.Students in nursing, medicine, pharmacy, dentistry, policy, and other health professions can think of the IHI Open School as their “other school” — an educational community that’s free and open no matter where they are.
The IHI Open School — including all of our online tools and resources, and our online courses — is open and free for students of all health care professions. During this limited prototyping phase, we are also making these resources available for free to non-students.
Youtube Channel
Patient-Centered Medical Home Demonstration
Group Health Cooperative based study
"A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with the goals of improving patient experience, lessening staff burnout, improving quality, and reducing downstream costs. Five design principles guided development of the PCMH changes to staffing, scheduling, point-of-care, outreach, and management....
After adjusting for baseline, PCMH patients reported higher ratings than controls on 6 of 7 patient experience scales. For staff burnout, 10% of PCMH staff reported high emotional
exhaustion at 12 months compared with 30% of controls, despite similar rates at baseline. PCMH
patients also had gains in composite quality between 1.2% and 1.6% greater than those of other patients. PCMH patients used more e-mail, phone, and specialist visits, but fewer emergency services. At 12 months, there were no significant differences in overall costs."
"A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with the goals of improving patient experience, lessening staff burnout, improving quality, and reducing downstream costs. Five design principles guided development of the PCMH changes to staffing, scheduling, point-of-care, outreach, and management....
After adjusting for baseline, PCMH patients reported higher ratings than controls on 6 of 7 patient experience scales. For staff burnout, 10% of PCMH staff reported high emotional
exhaustion at 12 months compared with 30% of controls, despite similar rates at baseline. PCMH
patients also had gains in composite quality between 1.2% and 1.6% greater than those of other patients. PCMH patients used more e-mail, phone, and specialist visits, but fewer emergency services. At 12 months, there were no significant differences in overall costs."
Thursday, September 10, 2009
Thursday, September 3, 2009
Wordles for health care research?
Johnathan Feinberg, the developer of Wordles has been exploring the way it can be used not only to analyse the difference between texts but communicate the differences graphically. He used the inaugural addresses of US Presidents but there will be many other uses, for example in comparing what patients and health care professional write or say.
Tuesday, September 1, 2009
Wednesday, August 26, 2009
Comparing patient talk to physician notes
From patient talk to physician notes—Comparing the content of medical interviews with medical records in a sample of outpatients in Internal Medicine Patient Education and Counseling Volume 76, Issue 3, Pages 336-340 (September 2009
An increasing number of consultations are delivered in group practices, where a stable 1:1 relationship between patient and physician cannot be guaranteed. Therefore, correct documentation of the content of a consultation is crucial to hand over information from one health care professional to the next.Methods: We randomly selected 20 interviews from a series of 56 videotaped consultations with patients requesting a general check-up exam in the outpatient department of Internal Medicine at the University Hospital Basel. All patients actively denied having any symptoms or specific health concerns at the time they made their appointment. Videotapes were analysed with the Roter Interaction Analysis System (RIAS). Corresponding physician notes were analysed with a category check-list that contained the information related items from RIAS.Results: Interviews contained a total of 9.002 utterances and lasted between 15 and 53min (mean duration: 37min). Patient-centred communication (Waiting, Echoing, Mirroring, Summarising) in the videos significantly correlated with the amount of information presented by patients: medical information (r=.57; p=.009), therapeutic information (r=.50; p=.03), psychosocial information (r=.41; p=.07), life style information (r=.52; p=.02), and with the sum of patient information (r=.64; p=.003). Even though there was a significant correlation between the amount of information from the video and information in physician's notes in some categories (patient gives medical information; Pearson's r=.45; p=.05, patient gives psychosocial information; Pearson's r=.49; p=.03), an inspection of the regression lines shows that a large extent of patient information is omitted from the charts. Physicians never discussed with patients whether information should be documented in the charts or omitted.Conclusions: The use of typical patient-centred techniques increases information gathered from patients. Physicians document only a small percentage of patient information in the charts, their ‘condensing heuristic’ is not shared with patients.Practice implications: Patient involvement should be advocated not only to medical decision making but also to the way physicians document the content of a consultation. It is a joint responsibility of patient and health care professional to decide, which information should be kept and thus be communicated to another health care professional in future consultations."
An increasing number of consultations are delivered in group practices, where a stable 1:1 relationship between patient and physician cannot be guaranteed. Therefore, correct documentation of the content of a consultation is crucial to hand over information from one health care professional to the next.Methods: We randomly selected 20 interviews from a series of 56 videotaped consultations with patients requesting a general check-up exam in the outpatient department of Internal Medicine at the University Hospital Basel. All patients actively denied having any symptoms or specific health concerns at the time they made their appointment. Videotapes were analysed with the Roter Interaction Analysis System (RIAS). Corresponding physician notes were analysed with a category check-list that contained the information related items from RIAS.Results: Interviews contained a total of 9.002 utterances and lasted between 15 and 53min (mean duration: 37min). Patient-centred communication (Waiting, Echoing, Mirroring, Summarising) in the videos significantly correlated with the amount of information presented by patients: medical information (r=.57; p=.009), therapeutic information (r=.50; p=.03), psychosocial information (r=.41; p=.07), life style information (r=.52; p=.02), and with the sum of patient information (r=.64; p=.003). Even though there was a significant correlation between the amount of information from the video and information in physician's notes in some categories (patient gives medical information; Pearson's r=.45; p=.05, patient gives psychosocial information; Pearson's r=.49; p=.03), an inspection of the regression lines shows that a large extent of patient information is omitted from the charts. Physicians never discussed with patients whether information should be documented in the charts or omitted.Conclusions: The use of typical patient-centred techniques increases information gathered from patients. Physicians document only a small percentage of patient information in the charts, their ‘condensing heuristic’ is not shared with patients.Practice implications: Patient involvement should be advocated not only to medical decision making but also to the way physicians document the content of a consultation. It is a joint responsibility of patient and health care professional to decide, which information should be kept and thus be communicated to another health care professional in future consultations."
Tuesday, August 25, 2009
Monday, August 24, 2009
Diabetes 2.0 Resources at Webicina
More than 200 million people suffer from diabetes worldwide and it is one of those medical conditions that are covered in details online. The medical blogosphere and the community sites are very rich in diabetes-related content. From Bertalan Mesko's Webicina site (also Weight Loss 2.0, Depression 2.0, Cancer 2.0, Pregnancy 2.0)
* Diabetes News and Forums
* Diabetes in the medical blogosphere
* Diabetes Podcasts and Interviews
* Community Sites and FaceBook Groups
* Microblogging: Twitter and Friendfeed
* Diabetes Wikis
* Diabetes videos, animations and videocasts
* Diabetes On Mobile
* Second Life, the virtual world
* Social Bookmarking and Diabetes
* Medical Search Engines
* Diabetes Slideshows
* Diabetes News and Forums
* Diabetes in the medical blogosphere
* Diabetes Podcasts and Interviews
* Community Sites and FaceBook Groups
* Microblogging: Twitter and Friendfeed
* Diabetes Wikis
* Diabetes videos, animations and videocasts
* Diabetes On Mobile
* Second Life, the virtual world
* Social Bookmarking and Diabetes
* Medical Search Engines
* Diabetes Slideshows
Saturday, August 22, 2009
Thinking Outside the Pillbox
In its new research brief, "Thinking Outside the Pillbox," NEHI addresses the root causes of poor patient medication adherence - a significant contributor to overall health care waste - and offers promising solutions to improve adherence, particularly among chronic disease patients
"Experts stress that patients not only vary across a continuum of knowledge (their health literacy, their understanding of their disease and so on), they vary across a continuum of willingness and ability to adhere as well. This variability among patients also extends to patients’ proclivity to persist in adherence over time – thus a successful adherence strategy must provide continuity of care and follow-up. The odds that an adherence strategy will be successful are related to how well the strategy can first identify the varying needs of individual patients, and then match services accordingly. An ideal adherence strategy should be patient-centered and holistic taking into account everything from lifestyle to cultural and belief systems."
"Experts stress that patients not only vary across a continuum of knowledge (their health literacy, their understanding of their disease and so on), they vary across a continuum of willingness and ability to adhere as well. This variability among patients also extends to patients’ proclivity to persist in adherence over time – thus a successful adherence strategy must provide continuity of care and follow-up. The odds that an adherence strategy will be successful are related to how well the strategy can first identify the varying needs of individual patients, and then match services accordingly. An ideal adherence strategy should be patient-centered and holistic taking into account everything from lifestyle to cultural and belief systems."
Prescription Medication Adherence: Provider and Patient Perspective (Focus Group Report)
Ted Eytan on the National Consumers League/AHRQ Focus group report: Prescription Medication Adherence (pdf)
"there are actually a broad array of technology approaches to supporting adherence, including reminder systems (whose innovation should be incorporated into a comprehensive strategy to be sure). Those technology approaches may be most cost-effectively applied as close to the provider patient relationship as possible, to include things like:
* An after-visit summary after every encounter (whether on the phone, e-mail, or in person), with an accurate medication list that the patient + family + support can verify and ask questions about
* Education aids in every encounter to promote understanding of medication use to include the “why?” as well as the “what?”
* Accessible two-way communication (phone, e-mail) before, during, and after every encounter. "
"there are actually a broad array of technology approaches to supporting adherence, including reminder systems (whose innovation should be incorporated into a comprehensive strategy to be sure). Those technology approaches may be most cost-effectively applied as close to the provider patient relationship as possible, to include things like:
* An after-visit summary after every encounter (whether on the phone, e-mail, or in person), with an accurate medication list that the patient + family + support can verify and ask questions about
* Education aids in every encounter to promote understanding of medication use to include the “why?” as well as the “what?”
* Accessible two-way communication (phone, e-mail) before, during, and after every encounter. "
Friday, August 21, 2009
Thursday, August 20, 2009
Subscribe to:
Comments (Atom)
Posts
