Crystal balls for PD care: How predictive models can help us see ahead.

APhA advances provider status initiative

Virtual Rounds Offer a Glimpse into the Future of Healthcare

Innovations

Interdisciplinary or team care is defined in the parameters document of the American Cleft Palate-Craniofacial Association (ACPA). Team care is generally accepted around the world as the best way to care for patients with clefts and other craniofacial anomalies. Ninety percent of the world’s population has access to only 10 % of world health resources. This leads to many barriers being present to providing interdisciplinary team care to children with clefts in developing countries. There are two ways to develop team care in places around the world where it does not exist. One is to travel with an interdisciplinary team to a developing country to provide care for patients with clefts and go to the same place over a long period of time. The second way is to bring providers from developing countries to the developed world to learn interdisciplinary team care for patients with clefts and help them take that care back to their home. The most important thing for a successful introduction of team care into an area by a mission trip group is a commitment to return to the same place at least yearly for a long period of time. This commitment allows follow-up of patients over a long period of time, keeping of longitudinal records, accomplishing sequenced reconstructions, introduction of speech therapy and orthodontic care as a component of treatment, and evaluation of outcomes. In addition, whenever possible, education of local providers can be carried out year after year until they can provide the care on their own without the team having to come. The ACPA Visiting Scholar Program is an excellent example of how an individual from a developing country with the knowledge and potential to bring interdisciplinary team care for cleft and craniofacial patients to that country can be nurtured and encouraged. Each year, one individual spends 6 weeks in North America visiting cleft and craniofacial teams and attends the ACPA annual meeting. The individual then returns to their home country and uses the knowledge they have gained to establish or improve interdisciplinary team care. This program has been in place now for 15 years, and numerous examples exist of how these people have brought team care back to their home countries.

Continuity of care is an integral aspect of high-quality patient care in primary care settings. In the Department of Family Medicine at Mayo Clinic, providers have multiple responsibilities in addition to clinical duties or panel management time (PMT). These competing time demands limit providers' clinical availability. One way to mitigate the impact on patient access and care continuity is to create provider care teams to collectively share the responsibility of meeting patients' needs. This study presents a descriptive characterization of patient care continuity based on provider types and PMT. Care continuity was measured by the percentage of patient a ppointments s een by a provider in their o wn c are t eam (ASOCT) with the aim of reducing the variability of provider care team continuity. The prediction method is iteratively developed to illustrate the importance of the individual independent components. An optimization model is then used to determine optimal provider mix in a team. The ASOCT percentage in current practice among care teams ranges from 46% to 68% and the per team number of MDs varies from 1 to 5 while the number of nurse practitioners and physician assistants (NP/PAs) ranges from 0 to 6. The proposed methods result in the optimal provider assignment, which has an ASOCT percentage consistently at 62% for all care teams and 3 or 4 physicians (MDs) and NP/PAs in each care team. The predictive model combined with assignment optimization generates a more consistent ASOCT percentage, provider mix, and provider count for each care team.

Highway agencies need to manage the utilization of their highway equipment assets to reduce fleet management costs, balance equipment use, and provide the required services. Predictive equipment utilization and operational cost models are required for optimal management; however, there are no widely accepted models for this purpose. Although the utilization data is collected by state DOTs, the literature does not show any specific statistical model to predict equipment utilization as a function of contributing factors such as asset age, fleet size, costs, and demand for service. This study will bridge this gap and develop a predictive model to estimate the utilization of fleet equipment. The main objective of this paper is to develop a set of predictive models to estimate the annual utilization of seven non-stationary highway equipment types based on several explanatory variables including their annual fuel cost, downtime hours, age, and weight. Furthermore, another set of models are fit to predict the annual operational cost for these equipment types based on the most important contributing factors. The prediction models are developed after a nationwide data collection. Several years of collected data from seven states are processed and used for model development. This research has identified annual mileage as an appropriate and widely used utilization metric. Various model structures to predict annual mileage are considered. The logarithmic function of annual mileage has provided the most appropriate structure. The final annual mileage predictive models have R-squared values that are between 0.65 and 0.89, which indicates a good fit for all models. The models are validated by performing several statistical tests and they have satisfied all required assumptions of regression analysis. The result of modeling and statistical analysis showed that the proposed models accurately estimated the utilization and operational cost for highway equipment assets.

OBJECTIVE: To support collaboration and clinician-targeted decision support, electronic health records (EHRs) must contain accurate information about patients' care providers. The objective of this study was to evaluate two approaches for care provider identification employed within a commercial EHR at a large academic medical center. METHODS: We performed a retrospective review of EHR data for 121 patients in two cardiology wards during a four-week period. System audit logs of chart accesses were analyzed to identify the clinicians who were likely participating in the patients' hospital care. The audit log data were compared with two functions in the EHR for documenting care team membership: 1) a vendor-supplied module called "Care Providers", and 2) a custom "Designate Provider" order that was created primarily to improve accuracy of the attending physician of record documentation. RESULTS: For patients with a 3-5 day hospital stay, an average of 30.8 clinicians accessed the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents, and 5.4 physician assistants. The Care Providers module identified 2.7 clinicians/patient (1.8 attending physicians and 0.9 nurses). The Designate Provider order identified 2.1 clinicians/patient (1.1 attending physicians, 0.2 resident physicians, and 0.8 physician assistants). Information about other members of patients' care teams (social workers, dietitians, pharmacists, etc.) was absent. CONCLUSIONS: The two methods for specifying care team information failed to identify numerous individuals involved in patients' care, suggesting that commercial EHRs may not provide adequate tools for care team designation. Improvements to EHR tools could foster greater collaboration among care teams and reduce communication-related risks to patient safety.

Threefold vs. fivefold cross validation in one-hidden-layer and two-hidden-layer predictive neural network modeling of machining surface roughness data

Data standards for interoperability of care team information to support care coordination of complex pediatric patients

BackgroundEmergency department boarding and hospital exit block are primary causes of emergency department crowding and have been conclusively associated with poor patient outcomes and major threats to patient safety. Boarding occurs when a patient is delayed or blocked from transitioning out of the emergency department because of dysfunctional transition or bed assignment processes. Predictive models for estimating the probability of an occurrence of this type could be useful in reducing or preventing emergency department boarding and hospital exit block, to reduce emergency department crowding.ObjectiveThe aim of this study was to identify and appraise the predictive performance, predictor utility, model application, and model utility of hospital admission prediction models that utilized prehospital, adult patient data and aimed to address emergency department crowding.MethodsWe searched multiple databases for studies, from inception to September 30, 2019, that evaluated models predicting adult patients’ imminent hospital admission, with prehospital patient data and regression analysis. We used PROBAST (Prediction Model Risk of Bias Assessment Tool) and CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) to critically assess studies.ResultsPotential biases were found in most studies, which suggested that each model’s predictive performance required further investigation. We found that select prehospital patient data contribute to the identification of patients requiring hospital admission. Biomarker predictors may add superior value and advantages to models. It is, however, important to note that no models had been integrated with an information system or workflow, operated independently as electronic devices, or operated in real time within the care environment. Several models could be used at the site-of-care in real time without digital devices, which would make them suitable for low-technology or no-electricity environments.ConclusionsThere is incredible potential for prehospital admission prediction models to improve patient care and hospital operations. Patient data can be utilized to act as predictors and as data-driven, actionable tools to identify patients likely to require imminent hospital admission and reduce patient boarding and crowding in emergency departments. Prediction models can be used to justify earlier patient admission and care, to lower morbidity and mortality, and models that utilize biomarker predictors offer additional advantages.

Disruption of Patient and Family Centered Care Through the COVID-19 Pandemic

Understanding Palliative Care on the Heart Failure Care Team: An Innovative Research Methodology

A new international framework for palliative care

Limited research has characterized team-based models of home palliative care and the outcomes of patients supported by these care teams. A retrospective case series describing care and outcomes of patients managed by the London Home Palliative Care Team between May 1, 2017 and April 1, 2019. The London Home Palliative Care (LHPC) Team care model is based upon 3 pillars: 1) physician visit availability 2) active patient-centered care with strong physician in-home presence and 3) optimal administrative organization. In the 18 month study period, 354 patients received care from the London Home Palliative Care Team. Most significantly, 88.4% (n = 313) died in the community or at a designated palliative care unit after prearranged direct transfer; no comparable provincial data is available. 21.2% (n = 75) patients visited an emergency department and 24.6% (n = 87) were admitted to hospital at least once in their final 30 days of life. 280 (79.1%) died in the community. These values are better than comparable provincial estimates of 62.7%, 61.7%, and 24.0%, respectively. The London Home Palliative Care (LHPC) Team model appears to favorably impact community death rate, ER visits and unplanned hospital admissions, as compared to accepted provincial data. Studies to determine if this model is reproducible could support palliative care teams achieving similar results.

Predictive analytics using electronic health record (EHR) data have rapidly advanced over the last decade. While model performance metrics have improved considerably, best practices for implementing predictive models into clinical settings for point-of-care risk stratification are still evolving. Here, we conducted a systematic review of articles describing predictive models integrated into EHR systems and implemented in clinical practice. We conducted an exhaustive database search and extracted data encompassing multiple facets of implementation. We assessed study quality and level of evidence. We obtained an initial 3393 articles for screening, from which a final set of 44 articles was included for data extraction and analysis. The most common clinical domains of implemented predictive models were related to thrombotic disorders/anticoagulation (25%) and sepsis (16%). The majority of studies were conducted in inpatient academic settings. Implementation challenges included alert fatigue, lack of training, and increased work burden on the care team. Of 32 studies that reported effects on clinical outcomes, 22 (69%) demonstrated improvement after model implementation. Overall, EHR-based predictive models offer promising results for improving clinical outcomes, although several gaps in the literature remain, and most study designs were observational. Future studies using randomized controlled trials may help improve the generalizability of findings.