Different Aspects Of Care Research Articles

Polycystic Ovary Syndrome: A Comprehensive Exploration of Diagnosis Experience in Saudi Women.

Background/Objectives: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, characterized by symptoms such as menstrual irregularities, hyperandrogenism, and polycystic ovaries. This study aimed to explore the diagnostic experiences of women with PCOS in Saudi Arabia, evaluating the timeline to diagnosis, the adequacy of information provided, and overall patient satisfaction with the healthcare process. Methods: A cross-sectional online survey was conducted with 1182 women diagnosed with PCOS across Saudi Arabia. The survey collected data on sociodemographic characteristics, the timeline from symptom onset to diagnosis, the number of healthcare visits required for diagnosis, and satisfaction with the information and support provided during the diagnostic process. Statistical analyses, including linear regression, were performed to identify factors influencing patient satisfaction. Results: The study found that 43.2% of participants sought medical attention within a year of symptom onset, yet significant delays in diagnosis were common, with 28.6% of women waiting six months or more after seeking medical care. Only 42.7% of women reported receiving adequate information at diagnosis, and satisfaction levels varied across different aspects of care. Key predictors of lower satisfaction included marital status and longer time since diagnosis, while quicker diagnosis and more healthcare visits before diagnosis positively influenced satisfaction. Conclusions: The findings highlight critical gaps in the diagnostic process and patient education for PCOS in Saudi Arabia. The widespread dissatisfaction with the information provided underscores the need for improved patient-centered care, comprehensive education, and standardized diagnostic protocols. Addressing these issues could enhance patient satisfaction and lead to better management of PCOS, both in Saudi Arabia and globally.

Quality of Endometrial Cancer Care from the Patients’ Perspective: A Cross-Sectional Study

Background: While patient perspectives in healthcare are recognized, endometrial cancer (EC) care quality and patient experiences remain understudied. Objective: To explore how women treated for EC perceived the quality of care during treatment and waiting times until diagnosis and surgery. Methods: Endometrial cancer patients (n = 684) diagnosed from January 2017 to March 2018 participated in the study 6–8 months after diagnosis. Data were collected digitally by means of the Quality from the Patient’s Perspective—Gynecological Cancer instrument. Each item (n = 27) was answered in 2 ways: both as actual care received and as perceived importance of different aspects of care. Results: The highest levels of perceived quality of actual received care and the corresponding subjective importance were reported to be related to physical-technical conditions, comprising the items “acceptable waiting times”, “access to necessary equipment”, and for the factor “respect and empathy from healthcare personnel”. The lowest levels were reported regarding information related to self-care and aspects of sexuality. Most of the women (79%) reported a less than 1-month waiting time until diagnosis and surgery, and >40% of the women experienced the waiting time as troublesome. Conclusions: Women perceived the quality of endometrial cancer care mostly as good or high, and age had limited impact. Implications for Practice: Information on self-care and aspects of sexuality, along with reducing waiting times needs improvement for reducing patient distress. What is Foundational: This study contributes to a better understanding of the quality of care among women with endometrial cancer during illness, treatment and early cancer rehabilitation.

Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

Caring and striving: toward a new consumer identity in the process of consumption reduction

Adoption of sufficiency-oriented lifestyles is an important part of curbing overconsumption, yet many individuals who try to reduce their consumption volumes experience social difficulties. Combining the perspectives of care and sufficiency-oriented lifestyle changes, this article aims to contribute to the understanding of why such social obstacles occur, how they might be counteracted and in what ways social relations instead may facilitate consumption reduction. Starting from an interview study with 25 Swedish consumption reducers, this article builds on a processual theory of consumer identity and the perspective of care to explore how care and consumption are (re)negotiated in the different stages of reduction. The results highlight the different aspects of care involved in consumption reduction – from motivations for change to negotiations toward a more holistic understanding of care – and show that consumption reduction in many ways is an ongoing process of both caring and striving. By emphasizing how care is renegotiated in a gradual construction of a caring consumer identity, this article discusses the importance of maintaining a sensitivity to the multi-faceted nature of care, acknowledging it both as a source of difficulties and as a key driver for sufficiency-oriented lifestyle changes.

Patient perspectives on the role of orthopedic nurse practitioners: a cross-sectional study

BackgroundThe inclusion of nurse practitioners (NPs) specializing in orthopedics shows potential for improving the quality of care for orthopedic patients. A critical aspect of assessing the feasibility and acceptance of introducing NPs into orthopedic settings involves understanding patients’ perspectives on this role. This study aims to explore the receptiveness of orthopedic patients to treatment by orthopedic Nurse Practitioners (NPs). Additionally, it investigates potential associations between patients’ willingness to engage with NPs, their familiarity with the NPs role, perceptions of nursing, and satisfaction with orthopedic nursing care.MethodsThis cross-sectional study involved patients admitted to an orthopedic department in a central Israeli hospital between January and February 2023. Data was collected using a questionnaire consisting of five sections, validated by content experts. Statistical analyses, performed using SPSS, included descriptive statistics, independent samples t-tests, Pearson correlations, and linear regression.ResultsOrthopedic patient participants demonstrated a moderate willingness to undergo treatment by orthopedic NPs, with over two-thirds expressing strong openness. Patients displayed a high willingness for NPs to engage in various clinical tasks, albeit showing lesser enthusiasm for medication management and preoperative evaluation. Positive attitudes towards nurses and familiarity with the NP’s role emerged as significant predictors of patient receptiveness to NPs’ treatment.ConclusionPatient acceptance of orthopedic NPs varies across different aspects of care. While there is overall willingness to receive care from NPs, these nuanced preferences should be considered when implementing NPs in orthopedic settings. Awareness and positive perceptions play crucial roles in shaping patients’ willingness to receive care from these NPs.Trial registrationThe research doesn’t report the results of a health care intervention.

Patient-Centered Outcomes in Bronchiolitis.

We examined the impact of hospitalization for bronchiolitis on patient-centered outcomes across patients with varying levels of support. The participants included primary caregivers of children aged 0 to 24 months hospitalized for bronchiolitis at an 150-bed tertiary care children's hospital. Data were collected using a 30-item questionnaire examining quality of life impact, adapted from the previously validated survey, the Impact of Bronchiolitis Hospitalization Questionnaire.1 The survey contained questions asking to what extent the hospitalization interfered with different aspects of care. After all surveys were collected, the patients were split into groups categorized by level of support and defined as no support, low support (low-flow nasal cannula only or nasogastric [NG] only), moderate support (high-flow nasal cannula without NG), high support (high-flow nasal cannula with NG support), and positive pressure (with or without NG support). Descriptive statistics were used to examine the distribution of mean impact scores across these groups. A total of 92 caregivers and their children were included. The mean impact score for variables of difficult to hold, difficult to bond, and breastfeeding disruption increased with greater levels of support with P values of P = .003, P = .04, and P < .001, respectively. We found that the impact on patient-reported outcomes varied by level of support, as defined here, among children hospitalized with bronchiolitis, with significant impacts being in areas of caregiver bonding, caregiver holding, and breastfeeding.

Abstract 16624: Patients’ Perspectives on the Impact and Management of Angina - Preliminary Results of the PACT-ANGINA International Survey

Introduction: PACT-ANGINA is a quality improvement initiative aimed to improve the understanding of challenges in the management of angina and chronic coronary syndromes. Hypothesis: An international patient survey is conducted to assess how angina and its management affect patients’ lives and what patients want in terms of the management of their angina. Methods: A working group that included 9 cardiologists and 7 patient representatives developed an online, anonymous questionnaire. Patients with angina were invited to take part in the survey by patient organizations and treating physicians. Results: Between January and June 2023, the survey was completed by 891 patients in 21 countries. The proportion of female patients was 46%. Among participants, 57% had been diagnosed with angina for 2 years or less, and 54% had never undergone a percutaneous coronary intervention. The proportion of patients with no history of smoking was 65% and the most common self-reported concomitant diseases were hypertension (49%), diabetes (38%) and dyslipidemia (23%). Pain, tightness, pressure or discomfort in the chest (89%), shortness of breath (44%), and fatigue (39%) were the most frequently reported symptoms, and 34% of participants felt that their physical activities were very or extremely limited by angina symptoms. The proportion of respondents who felt that angina was having a great or extreme impact on their quality of life was 37%. When asked to rate the relative importance of 9 treatment objectives, respondents assigned the highest priority to 1) reducing angina attacks and symptoms, 2) avoiding hospitalizations, and 3) prolonging their life as much as possible. Among different aspects of care, those considered the most important by respondents to improve the management of their angina were 1) a better follow-up of their symptoms, 2) practical and easy-to-understand information, and 3) lifestyle changes counseling. Conclusions: This study demonstrates that patients with angina are often limited by their symptoms, which impact their quality of life. Patient-centered management of angina is necessary to improve clinical care of such a common cardiac condition.

Survey of Spanish hospitals on diabetes care resources

IntroductionThe quality of diabetes care varies from region to region. The objective of this study is to analyze the characteristics of care in different hospitals in Spain through a specific survey assessing different aspects of care for both children and adults. Materials and methodsCross-sectional observational voluntary survey study, sent to the heads of the Endocrinology and Pediatric Endocrinology Departments or Units in public hospitals with more than 150 beds, during the first semester of 2021. A total of 105 responses were obtained, 55.5% of the 189 requested, which corresponded to a population served of 31,782,409 people, representing almost 80% of the total population served. ResultsPatients with diabetes under 15 years of age are cared for by Pediatric Departments, but only 58% of them have a specific Diabetes Education Unit for children, and in 72% of the cases, there is one single nurse dedicated to these tasks, and not always full-time. Those over 15 years of age are attended by specialists in Endocrinology and Nutrition in 94.3 % of hospitals. There are Therapeutic Education Units in Diabetes in practically all hospitals (94.3%). However, Diabetes Day Hospitals exist in only 32 centres and cover 40.3% of the population, since in 22 provinces there are none. Virtual and telematic consultations, as well as retinography, are available in more than 70% of cases, but access to a Diabetic Foot Unit only in 54% of centres. Monographic technological consultations on diabetes have become widespread, but access to mental health specialists with diabetes training remains limited (24% of centres), and interdisciplinary (32%) or interlevel (12%) committees are very scarce. ConclusionDiabetes care in Spain shows great variability from one region to another, and some deficiencies have been detected that affect a large part of the population, such as access to Diabetic Foot Units, as well as mental health specialists with specific training. The presence of multidisciplinary and mixed committees between levels of care remains scarce.

Encuesta a los hospitales españoles sobre los recursos de atención a la diabetes

IntroductionThe quality of diabetes care varies from region to region. The objective of this study is to analyze the characteristics of care in different hospitals in Spain through a specific survey assessing different aspects of care for both children and adults. Materials and methodsCross-sectional observational voluntary survey study, sent to the heads of the Endocrinology and Pediatric Endocrinology Departments or Units in public hospitals with more than 150 beds, during the first semester of 2021. A total of 105 responses were obtained, 55.5% of the 189 requested, which corresponded to a population served of 31,782,409 people, representing almost 80% of the total population served. ResultsPatients with diabetes under 15 years of age are cared for by Pediatric Departments, but only 58% of them have a specific Diabetes Education Unit for children, and in 72% of the cases, there is one single nurse dedicated to these tasks, and not always full-time.Those over 15 years of age are attended by specialists in Endocrinology and Nutrition in 94.3% of hospitals. There are Therapeutic Education Units in Diabetes in practically all hospitals (94.3%). However, Diabetes Day Hospitals exist in only 32 centers and cover 40.3% of the population, since in 22 provinces there are none. Virtual and telematic consultations, as well as retinography, are available in more than 70% of cases, but access to a Diabetic Foot Unit only in 54% of centers.Monographic technological consultations on diabetes have become widespread, but access to mental health specialists with diabetes training remains limited (24% of centers), and interdisciplinary (32%) or interlevel (12%) committees are very scarce. ConclusionDiabetes care in Spain shows great variability from one region to another, and some deficiencies have been detected that affect a large part of the population, such as access to Diabetic Foot Units, as well as mental health specialists with specific training. The presence of multidisciplinary and mixed committees between levels of care remains scarce.

The quality of prison primary care: cross-sectional analyses of prison healthcare data in Northern England.

Prisoners have considerable health needs, are relatively high users of health care and often die prematurely. Prison healthcare research has typically focused on specific problems such as substance misuse, but 'routine' primary care has received less attention. Strong primary care systems are associated with better population outcomes. Identifying inappropriate variations in care will inform strategies to close gaps in health care and reduce preventable deaths. To explore variations in the quality of primary care for prisoners. We assessed achievement against 30 quality indicators examining different aspects of care in 13 prisons. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records across 2017-2020. Multi-level logistic regression models explored associations between indicator achievement and prison and prisoner characteristics. We found marked variations in achievement between different indicators and different prisons. Achievement ranged from 0·2% of people with epilepsy coded as seizure-free, to 93·8% of people with diabetes having blood pressure checks, in the preceding year. Achievement improved over three years for 11 indicators and worsened for six, including declining antipsychotic monitoring and rising opioid prescribing. Achievement varied between prisons, from 1·93-fold for prescribing of gabapentinoids with no coded diagnosis of neuropathic pain (Odds Ratio (OR) range 0·67 to 1·29) to 21,610-fold for medicine reconciliation (OR range 0·45 to 9724·5). Shorter lengths of stay were frequently associated with lower achievement. Some associations between ethnicity and achievement were identified. We found substantial scope for improvement and marked variations in quality which were largely unaltered after adjustment for prison and prisoner characteristics.

Implementation Science in Surgery: Translating Outcomes to Action.

Implementation Science in Surgery: Translating Outcomes to Action.

252 VTUESDAYS: A QUALITY IMPROVEMENT PROJECT TO EMBED THROMBOPROPHYLAXIS REVIEWS IN AN INTERMEDIATE CARE REHABILITATION SETTING

Abstract Background Venous Thrombo-Embolism (VTE) can be life-threatening. Risk assessment and mitigation is essential to reduce morbidity and mortality in all clinical settings. Northern Ireland Health and Social Care has a standardised, regional thromboprophylaxis risk assessment tool as part of paper-based drug charts in the acute, secondary care setting. Intermediate care setting drug charts incorporate this same tool. The 30-bedded pilot site cares for step-down patients from the acute hospital setting from surgical, orthopaedic and medical specialties, for those aged over 18 years requiring bed-based rehabilitation. Regularisation of reviews of risk assessments to address changes in VTE risk was identified as a need to avoid under-prescribing and over-prescribing. Methods Quality improvement methodology was used. Pre-phase, semi-structured interviews with stakeholders took place. An Ishikawa diagram analysed contributory factors to risks. A Sinek circle distilled intentions. A Clinical Value Compass map considered potential outcomes. A vision of “VTuEsdays” was co-designed. Global and specific aims informed driver diagrams. Plan, Do, Study, Act iterations were used in the implementation phase including a decision support tool to guide the appropriateness of deprescribing on the basis of rehabilitation trajectory and changing VTE risk. Results We collected baseline data and implemented education of staff working in the intermediate care centre, utilising the ‘PDSA’ Model to guide changes. A bright and easy to use flowchart was used with the title ‘VTuEsdays’. This encouraged the process of VTE risk assessment and weekly review on a Tuesday. There were improvements in: the completion rate of risk assessment tool; the accuracy of this assessment; the under-prescribing and over-prescribing of thromboprophylaxis. Conclusion The “VTuEsdays” themed day helped ameliorate under-prescribing and over-prescribing of thromboprophylaxis in an intermediate care bed-based rehabilitation setting. Quality improvement methodology enables a robust approach to risk mitigation. Similar themed days for regularisation of reassessment of clinical risk management in intermediate care settings could improve different aspects of care.

P.24 Consensus and collaboration approach to better defining and implementing harmonised standards of care across a healthcare system: Examples from DMD care

Through the DMD care UK project, a collaborative initiative between clinicians and patients, we have established an extensive, methodologically robust consultation process across all aspects of Duchenne muscular dystrophy (DMD) care. Initial benchmarking of current clinical care in the UK [against international recommendations (SoC)] and surveys of patient experience have been followed by a review of evidence and expert opinion by a series of specialist working groups. These groups were established to focus on different aspects of care but are all interlinked to ensure a multidisciplinary approach to the care of DMD. Each group includes patients or patient representatives and clinical experts from the UK North Star Clinical Network of specialist neuromuscular centres. This has led to consensus-building across different centres in all areas of care. Results from the first phases, including guidance from the endocrine and cardiac working groups, will be presented as a powerful illustration of the benefits of this approach. This highly successful model means that DMD Care UK has already effected change. We demonstrate examples of this through: endorsement of the first groups' consensus-built recommendations by UK professional bodies; tangible awareness-raising amongst clinicians by facilitation of group to group cross-talk; increased patient-community engagement in SoC development and dissemination; increased clinician engagement and network-building; securing of funding for clinical psychology and neuropsychiatry posts to address the identified gaps in psychosocial support for DMD; the release of an emergency care app to ensure that people with DMD get prompt and appropriate care in an emergency. We propose that this model of consensus building, awareness raising and collaboration improves the SoC for patients and empowers them to become active participants in their care. This model could be extended to other disease areas and other health systems.

Sex-related differences in health-care use in adult patients with inflammatory arthritis in Ontario, Canada: a population-based cohort study

<h2>Abstract</h2><h3>Background</h3> Timely access and appropriate use of health-care resources is crucial for the management of people with inflammatory arthritis. Sex (biological) and gender (sociocultural) are important health determinants that influence different aspects of care, such as referral to specialists, performance of diagnostic tests, continuity of care, and prescription patterns, which ultimately affect disease outcomes. We aimed to compare health-care use between males and females with inflammatory arthritis. <h3>Methods</h3> This population-based study was conducted using health administrative data of Ontario, Canada. We included Ontario residents aged 20 years or older with valid health insurance and diagnosed with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis using Ontario health administrative data (the Ontario Health Insurance Plan Claims Database). Sex (the primary predictor of this study) was coded as male or female in the database. Health-care use (the study outcome) was assessed at least once per year for 3 years before and after an inflammatory arthritis diagnosis and compared between males and females using regression models, after adjusting for demographics and comorbidities. Prescription dispensation was assessed at least once per year for 3 years after the diagnosis in individuals aged 66 years or older at the time of diagnosis. Results were expressed as female to male adjusted odds ratio (OR) with 95% CIs. <h3>Findings</h3> Between April 1, 2010, and March 31, 2017, 41 277 people with rheumatoid arthritis (28 575 [69%] females), 8150 with ankylosing spondylitis (4160 [51%] females), and 6446 with psoriatic arthritis (3483 [54%] females) were analysed. Males were significantly older (mean 60·4 years [SD 14·2]) than females (mean 57·1 years [15·2]) in the rheumatoid arthritis cohort. Across the cohorts, multimorbidity was more common in females (75–81% <i>vs</i> 58–66% in males) as was depression (8% <i>vs</i> 4%) and osteoporosis (4–5% <i>vs</i> 1%), whereas cardiovascular disease was more common in males (7–15% <i>vs</i> 4–7% in females). Females were more likely to visit family physicians (adjusted OR ranging from 1·10 [95% CI 1·05–1·15]; p<0·001 to 1·15 [1·04–1·28]; p<0·01) and rheumatologists (adjusted OR from 1·32 [1·22–1·43] to 2·28 [1·92–2·70]; p<0·001). Females also had higher odds for receiving imaging before a diagnosis in all 3 cohorts (adjusted OR from 1·15 [1·10–1·20] to 1·18 [1·12–1·23]; p<0·001 for x-rays and adjusted OR from 1·27 [1·09–1·48] to 1·44 [1·15–1·80]; p<0·01 for ultrasound examinations). Similarly, laboratory tests were more likely to be ordered for female patients before diagnosis than for males (adjusted OR from 1·10 [1·05–1·15] to 2·17 [1·89–2·50]; p<0·001) across all cohorts. These sex differences were most notable among people with rheumatoid arthritis and ankylosing spondylitis, and in the prediagnostic period. Males were more likely to visit the emergency department immediately before an inflammatory arthritis diagnosis (adjusted OR from 0·76 [95% CI 0·72–0·81]; p<0·001 to 0·87 [0·80–0·95]; p<0·01). After diagnosis, females were more likely to remain in rheumatology care (adjusted OR from 1·12 [1·01–1·25]; p=0·04 to 1·24 [1·19–1·30]; p<0·001). Prescription dispensation of non-steroidal anti-inflammatory drugs (adjusted OR 1·14 [1·04–1·25]; p<0·01) and opioids (adjusted OR 1·46 [1·27–1·68]; p<0·001) was higher in older females (aged 66 years or older) with rheumatoid arthritis and conventional disease-modifying antirheumatic drug use was higher in older females with ankylosing spondylitis (adjusted OR 1·66 [1·24–2·22]; p<0·001). <h3>Interpretation</h3> Females with inflammatory arthritis are more likely to use health care than males, which might indicate sex-related biological differences in disease course or gender-related sociocultural differences in health-care access, health-care seeking behaviour or patient–provider interactions. <h3>Funding</h3> Enid Walker Graduate Student Award for Research in Women's Health (partial).

Hospital Performance for Gastrointestinal Bleeding Mortality, Length of Stay, and Complication Rates in the USA.

Hospitals are held accountable for quality metrics, through public reporting programs and by payers. However, little is known about hospital performance in GIB nationally. A retrospective longitudinal analysis utilizing Vizient's database was performed to identify GIB hospitalizations across 349 hospitals from 2016 to 2018. The primary outcome was risk-adjusted mortality; secondary outcomes included risk-adjusted length of stay and complication rate. Trends in performance were characterized using quintiles, with analysis of concordance within hospitals and across hospitals over time. Pearson's correlation coefficients were performed to assess the relationship among metrics. 28.1% of hospitals had a steadily improving risk-adjusted mortality index from 2016 to 2018, while 15.5% were steadily worsening in mortality. For LOS, 25.2% of hospitals were improving, while 22.4% deteriorated. For complication rate, 22.9% of hospitals steadily improved, while 19.2% of hospitals deteriorated. Although many hospitals improved substantially in one outcome, they did not necessarily improve in all outcomes. Of the 98 hospitals that steadily improved in mortality from 2016 to 2018, only 8 out of 98 steadily improved in all three outcomes (8.3%). Across all 3years, mortality was weakly correlated with LOS (r = 0.22, p < 0.001), but not with the rate of complications (r = 0.08, p = 0.12). Hospital performance metrics for GIB, such as mortality, length of stay, and complication rate, are weakly correlated and thus likely measure different aspects of care. While many hospitals improved over time, few hospitals improved in all three metrics. Additionally, many hospitals are deteriorating over time, and further research is needed to determine which care processes are associated with better outcomes.

A Housing First evaluation project for homeless Veterans in Canada: Quantitative findings

LAY SUMMARY This study sought to evaluate a Housing First program for Veterans experiencing homelessness. Housing First is an approach made up of many different aspects of care including peer support and greater access to care resources within the home. These aspects of care are offered in order to address underlying issues and maintain housing stability. The program was implemented across four cities in Canada including London, Toronto, Calgary, and Victoria. To assess the program, interviews with Veterans were conducted at time of enrollment, 3, 9, and 15 months. The Veterans in this study demonstrated a significant reduction in homelessness. As well, a significant reduction in emergency room visits was reported. Other health care interactions and quality-of-life scores remained stable. These findings could, therefore, lead to potential future cost savings in the health care sector. This study demonstrates why this approach to housing for Veterans can be a highly effective and useful way to ensure housing stability.

62 Network Analysis To Understand Regional Patient Flow

Consolidation of health care systems in the United States has created integrated enterprises with large geographical reach and complex interacting components. Specialty services vary among sites, and patients often need to travel between facilities for different aspects of care. Network science is an established method employed to investigate these complex systems, and can be used to identify bottlenecks, opportunities to increase value and patient-centeredness in health care. The COVID-19 pandemic changed care demand patterns unexpectedly. We wanted to investigate if network analysis would allow us to better understand these changes and challenges - where our patients receive hospital-based care, what services they used and how far they travelled. We focused this analysis on a multispecialty, tertiary care academic center emergency department (“AC_ED”), with 70,000 patient visits annually. We extracted patient location information from electronic health records, including originating location and level of care, to create a network representation of all care pathways that passed through our ED. The volume of transfers between nodes and the distance travelled were encoded as weighted/colored edge attributes, with edges between nodes in closer proximity being darker. Nodes include: communities within our service area, EDs, and academic center units, and an outcome of mortality. They are sized/colored by betweenness centrality, reflecting the importance of the node in the integrity of the network. The figure shows the overall network structure was similar for pre- and post-pandemic onset with some changes in details. AC_ED receives patients from many home locations and referring hospitals. A large proportion of visits come from the local area reflected by M16 and M12. There are many patients who travel far to access emergency care at AC_ED, bypassing local EDs though the average distance travelled to access care reduced from 114 to 85 miles. During the pandemic there was more traffic to the AC_ED from the local area (M16), fewer connections to surrounding hospitals and disproportionately reduced visits from distant areas (O and OT). Low ED volumes and restricted outpatient clinic availability during the pandemic time frame likely affected this. Inter-hospital transfer volumes declined overall, several sites transferred very few patients to AC_ED post-pandemic start, and other sites increased their transfer rate (eg, CAH13). Looking at hospital systems through the lens of network science can reveal changes in patterns of referrals, allows for identification of unexpected results by presenting data visually and can assist identifying crucial components of a health care system. Application of this methodology to other variables has the potential to identify new areas of improvement to increase value, outcomes and services to improve patient-oriented care.

Patients' perception on the quality of care for multiple endocrine neoplasia disorders in Europe: an online survey from a patient support group.

European Patient Advocacy Groups (ePAGs) within the Endo-ERN identified a lack of knowledge about quality of care (QoC) of patients with multiple endocrine neoplasia (MEN). The aim of this study was to identify inequalities in care and to encourage improvements. The European MEN Alliance (EMENA) developed and conducted a survey, using the European Commissions' EUSurvey platform. Patient groups and healthcare professionals (HCPs) distributed the survey. A total of 288 participants completed the survey (MEN1 n = 203, MEN2 n = 67, MEN3 n = 18) from 18 European countries. The majority of respondents were recruited via patient groups (58%), aged between 41 and 60 years (53%) and were female (67%). All participants reported having been diagnosed on average 5.58 years (95%-CI: 4.45-6.60) after first symptoms occurred. This timeframe was lower in the group with MEN2 (2.97 years, 95%-CI: 1.37-4.57). Most of the participants (67%) received their diagnosis by a positive gene test after presenting with one or more MEN-related tumours. Overall QoC was rated as either "good" (43%) or "excellent" (36%). The results of this unique Europe-wide, patient-driven survey on QoC of patients with MEN show that ratings for overall QoC were lower than ratings for different aspects of care. This may be because of the complex nature of care for genetic syndromes. Furthermore, patients who connect with patient groups may be deemed "expert patients" whose answers are not representative of the overall MEN patient community. We hope that Endo-ERN can support further education and training for HCPs based on these results.

Children's palliative care: examination of a nursing rotation programme.

An 8-month rotation programme was implemented for five nurses employed in two kinds of children's palliative care environments: hospital wards and hospices. This study reports the views of the nurses completing the rotation. The research drew on appreciative inquiry and involved a pre- and post-rotation interview and questionnaire. Thematic analysis of the interviews revealed seven themes: adjusting to the rotation programme; support mechanisms; being safe; new knowledge and skills; knowledge exchange; misconceptions; future plans. These were supported by the questionnaire findings. Although the nurses identified some frustration at having to undertake competency assessments relating to previously acquired skills, as well as being out of their 'comfort zone', all the participants highly recommended the programme. They commented very positively on the support they received and the overall learning experience as well as the new insight into different aspects of care. In addition, they were able to share their newfound knowledge and expertise with others.

What patients like or dislike in physicians: Analyzing drivers of patient satisfaction and dissatisfaction using a digital topic modeling approach

A large volume of patients’ opinions—as online doctor reviews (ODRs)—are available online in order to access, analyze, and improve patients’ perceptions about the quality of care; however, this development needs to be explored further. Drawing on the two-factor theory, this paper aims to mine ODRs to explore the different determinants of patient satisfaction (PS) and patient dissatisfaction (PD) toward the United Kingdom healthcare services. This study collects reviews from a publicly available medical website Iwantgreatcare.org from January 2014 to December 2018, followed by the text mining method based on combining SentiNet and LDA to disclose the semantics of patients’ healthcare experiences. The proposed method found latent topics across the high-risk and low-risk disease category that revealed new insights into what patients value when consulting a physician and what they dislike. For high-risk and low-risk diseases, the determinants of PS were more specific to the hospital business process (hospital environment, location, hospital cafeteria servicescape, parking availability, and medical process, etc.) and doctor-related aspects (physician knowledge, competence, and attitudes, etc.). In contrast, patients’ concerns were most commonly related to their treatment experience and staff bedside manners for both disease categories. Finally, the classification results revealed that the proposed model, which analyzes patient opinion toward different aspects of care, outperformed other state-of-the-art models, with the highest classification F1-score of 88%. The study findings provide a clue for doctors, hospitals, and government officials to enhance PS and minimize PD by addressing their needs and improve the quality of care across different types of diseases, particularly in the current pandemic era of COVID-19.