Goal Of Health Care Research Articles

Screening for Fetal Chromosomal Abnormalities: ACOG Practice Bulletin, Number 226.

Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.

The Influence of Personality and Anxiety Traits on Birth Experience and Epidural Use in Vaginal Deliveries – A Cohort Study

ABSTRACT A positive birth experience for the mother is an important goal in obstetric health care and is influenced by several factors. For this study, 186 women filled in questionnaires between 24 and 72 hours after giving birth vaginally. We evaluated the Big-Five personality traits (extraversion, neuroticism, openness, conscientiousness and agreeableness), trait anxiety, different dimensions of childbirth experience and pain management. Correlation analysis revealed that trait anxiety and neuroticism were negatively associated with several dimensions of the birth experience. Furthermore, conscientiousness and extraversion were positively correlated with the dimension Participation. Regression analysis for the individual dimensions and overall score respectively, confirmed the independent impact of anxiety trait on Perceived Safety, Participation and Professional Support and the overall score as well as of neuroticism on Perceived Safety and conscientiousness on Participation. The significant regression models showed small R2-scores (.084–.154). The birth experience did not differ whether the women received an epidural or not. Women who did not receive an epidural displayed higher scores on the personality trait conscientiousness. The study highlights small but important associations between personality traits and birth experience in vaginal births which should sensitize the medical staff when supporting women during labor.

Impact of Hearing Loss and Universal Face Masking in the COVID-19 Era

Impact of Hearing Loss and Universal Face Masking in the COVID-19 Era

SMART on FHIR in spine: integrating clinical prediction models into electronic health records for precision medicine at the point of care

Recent applications of artificial intelligence have shown great promise for improving the quality and efficiency of clinical care. Numerous clinical decision support tools exist in today's electronic health records (EHRs) such as medication dosing support, order facilitators (eg, procedure specific order sets), and point of care alerts. However, less has been done to integrate artificial intelligence (AI)-enabled risk predictors into EHRs despite wide availability of validated risk prediction tools. An interoperability standard known as SMART on FHIR (substitutable medical applications and reusable technologies on fast health interoperability resources) offers a promising path forward, enabling digital innovations to be seamlessly integrated with the EHR with regard to the user interface and patient data. For the next step in progress towards the goal of learning healthcare and informatics-enabled spine surgery, we propose the application of SMART on FHIR to integrate existing and new risk predictions tools in spine surgery through an EHR add-on-application.

The Influence of Career Choice on Neurological Academic Performance Among Critical Care Students In Abuja, Nigeria

In Nigeria, Critical care is yet to subspecialize; the neurology curriculum is a core subject. The evidence of career choice motivation and neurological academic performance has not been well elucidated, as such, demonstrating a valid premise that critical care students choice resulted in better academic performance will be very useful. The value can be seen in improved students' guidance, better curriculum development and improved healthcare setting goals. This study was set up to ascertain the relationship between career choice motivators and learning outcomes among critical care nursing students with emphasis on neurological curriculum. A cross sectional quantitative descriptive study and analysis techniques were explored using three academic sessions of critical care nursing students of the School of Post Basic Critical Care Nursing of University of Abuja, Nigeria. Responses to the question “why did you choose critical care nursing” were collated and then themes developed. Their score in neurology was used to assess academic performance. Statistical analysis conducted using IBM-SPSS version 23. Ninety students responded with males constituting 24 (26.7) and females, 66 (73.3). There was statistical difference between 'passion for critically ill', 'having no reason' and academic performance, (χ2=8.707, p=0.003), and (χ2=13.306, p <0.001) respectively. Passion was found to be responsible for career choice and motivating influence on neurocritical academic performance.

Slowing Medicare Spending by Optimizing Late-Life Needs

Summary In this article, we highlight three care delivery innovations that could be implemented by Medicare Advantage plans as a late-life care model to better meet the needs of older adults and reduce per capita spending. The elements of this model include (1) community (engaging well-functioning seniors as in-home health workers), (2) capability (improving seniors’ functional capabilities and home environments), and (3) communication (using telemediated behavioral health specialists to help patients articulate their health care goals). We propose that these solutions fall within the scope of the recently expanded Medicare Advantage supplemental benefits, and we estimate that the new care model would offer substantial annual savings for the Medicare Advantage population and individual plans.

COVID-19 Digital Health Innovation Policy: A Portal to Alternative Futures in the Making.

"The pandemic is a portal." In the words of the novelist scholar Arundhati Roy, the COVID-19 pandemic is not merely an epic calamity. It has opened up a new space, a portal, to rethink everything, for example, in how we live, work, produce scientific knowledge, provide health care, and relate to others, be they humans or nonhuman animals in planetary ecosystems. Meanwhile, as the intensity of the pandemic escalates, digital health tools such as the Internet of Things (IoT), biosensors, and artificial intelligence (AI) are being deployed to address the twin goals of social distancing and health care in a "no touch" emergency state. Permanent integration of digital technologies into every aspect of post-pandemic civic life-health care, disease tracking, education, work, and beyond-is considered by governments and technology actors around the world. Although digital transformation of health care and industry are in the works, we ought to ensure that digital transformation does not degenerate into "digitalism," which we define here as an unchecked and misguided belief on extreme digital connectivity without considering the attendant adverse repercussions on science, human rights, and everyday practices of democracy. Indeed, the current shrinking of the critically informed public policy space amid a devastating pandemic raises principled questions on the broader and long-term impacts that digital technologies will have on democratic governance of planetary health and society. To this end, a wide range of uncertainties-technical, biological, temporal, spatial, and political-is on the COVID-19 pandemic horizon. This calls for astute and anticipatory innovation policies to steer the health sciences and services toward democratic ends. In this article, we describe new and critically informed approaches to democratize COVID-19 digital health innovation policy, especially when the facts are uncertain, the stakes are high, and decisions are urgent, as they often are in the course of a pandemic. In addition, we introduce a potential remedy to democratize pandemic innovation policy, the concept of "epistemic competence," so as to check the frames and framings of the pandemic innovation policy juggernaut and the attendant power asymmetries. We suggest that if epistemic competence, and attention to not only scientific knowledge but also its framing are broadly appreciated, they can help reduce the disparity between the enormous technical progress and investments made in digital health versus our currently inadequate understanding of the societal dimensions of emerging technologies such as AI, IoT, and extreme digital connectivity on the planet.

Personal-recovery-oriented community mental healthcare: qualitative evaluation of a developmental project.

ObjectivesMental healthcare is commonly aimed at reducing symptoms in individual service users. When only symptomatic recovery is addressed, not all service users experience sufficient recovery, and when care is aimed only at individuals (instead of the neighbourhood), not all people in need of mental healthcare are reached. This study evaluated a project that aimed to improve mental healthcare in a neighbourhood, by improving healthcare providers’ outreach to the residents living in the neighbourhood, by improving collaboration among healthcare providers and focussing on the residents’ personal recovery. This project was carried out by several public health services. It aimed to change the goal of mental healthcare provided in the neighbourhood from symptom reduction to personal recovery.DesignThe study included qualitative focus groups and inductive content analysis.SettingPrimary and secondary mental healthcare that healthcare workers from different healthcare services provided.ParticipantsThe evaluation was conducted through three focus group interviews with services users, their friends and relatives, neighbourhood residents, neighbourhood representatives and the healthcare services that were involved (n = 24).ResultsEvaluation indicated that the most valued part of the project was the utilisation of peer workers at the initiation of mental healthcare. Improved communication among healthcare providers that the project fostered was also highly regarded. The aim of the project to align it with existing initiatives in the neighbourhood was also considered important, although it was difficult to achieve.ConclusionsThe project did not find a panacea for recovery-oriented community mental healthcare. A variety of its components did, however, contribute to the mental health of the community residents.

Manifestations of Economic Resilience in Hospitals: What do managers say?

Introduction: The area of healthcare requires crucial measures in the area of economic resilience. Regarding the important role of hospital managers in reaching the healthcare goals and realizing instances of the economic resilience in hospitals, the present study was conducted. The aim was to explore the perception of educational and healthcare centers’ managers in Isfahan regarding the concept and instances of economic resilience in hospitals. Method: The data needed for this qualitative descriptive exploratory study were collected using semi structured interviews With 11 managers of educational and medical centers in Isfahan. Thematic analysis was used for the analysis. Result: The concept of economic resilience included supporting domestic products, productivity, optimal use of resources, economy in consumption, strategic purchase, difference between economic resilience and economic austerity, and moving away from a mono-product oil-based economy. The basic components in instances of economic resilience included: drugs and equipment, human resources, financial management, installation and hoteling, consumption management, management and leadership, and information technology. Conclusion: Due to the lack of a comprehensive definition about the concept of economic resilience from the participants' perspective, the goals of the economic resilience would not be achieved unless the executive authorities in large or small scale administration level conform to the ideas mentioned by the Supreme Leader of Iran.

Patient-Reported Receipt of Goal-Concordant Care Among Seriously Ill Outpatients—Prevalence and Associated Factors

ContextGoal-concordant care is an important indicator of high-quality care in serious illness. ObjectivesTo estimate the prevalence of patient-reported receipt of goal-concordant care among seriously ill outpatients and identify factors associated with the absence of patient-reported goal concordance. MethodsAnalysis of enrollment surveys from a multicenter cluster-randomized trial of outpatients with serious illness. Patients reported their prioritized health care goal and the focus of their current medical care; these items were matched to define receipt of goal-concordant care. ResultsOf 405 patients with a prioritized health care goal, 58% reported receipt of goal-concordant care, 17% goal-discordant care, and 25% were uncertain of the focus of their care. Patient-reported receipt of goal concordance differed by patient goal. For patients who prioritized extending life, 86% reported goal-concordant care, 2% goal-discordant care, and 12% were uncertain of the focus of their care. For patients who prioritized relief of pain and discomfort, 51% reported goal-concordant care, 21% goal-discordant care, and 28% were uncertain of the focus of their care. Patients who prioritized a goal of relief of pain and discomfort were more likely to report goal-discordant care than patients who prioritized a goal of extending life (relative risk ratio 22.20; 95% CI 4.59, 107.38). ConclusionSeriously ill outpatients who prioritize a goal of relief of pain and discomfort are less likely to report receipt of goal-concordant care than patients who prioritize extending life. Future interventions designed to improve receipt of goal-concordant care should focus on identifying patients who prioritize relief of pain and discomfort and promoting care aligned with that goal.

Is health expenditure effective for achieving healthcare goals? Empirical evidence from South-East Asia Region

This study examines the effectiveness of health expenditure on healthcare goals in South-East Asia Region for the period from 2000 to 2014 using system generalized method of moment model. In this study, aggregate health expenditure data have been divided into two components—public and private. Both public and private health expenditure components are segregated into four categories of expenditure—government health expenditure from domestic sources, external assistance of health to the government, private out-of-pocket (i.e., household expenditure), and private not out-of-pocket (i.e., insurance). Certain health status indicators have been adopted as healthcare goals—life expectancy, infant mortality, universal health coverage index; immunization coverage, the prevalence of undernourishment, and Tb cases detection rate. The empirical result finds that aggregate health expenditure, especially public health expenditure, shows positive effects on the improvement in life expectancy and reduction of infant mortality. But the relationship between health expenditure and healthcare goals is weak (i.e., inelastic) and the elasticity values are numerically small than the non-health factors especially female education and per capita income. We have found a strong positive association between health expenditure and universal health coverage index that implies a 1% increase in public health expenditure leads to a 0.26% rise in healthcare services coverage. Further, female education has shown strong effects on the reduction of undernourishment population and increase immunization coverage. Increased public expenditure on health through domestic revenue generation and improved government effectiveness could be suggestive policy implications for achieving better health outcomes.

Community pharmacy and primary health care in Sweden - at a crossroads

The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.

Effects of stigma, hope and social support on quality of life among Chinese patients diagnosed with oral cancer: a cross-sectional study

BackgroundImproving quality of life (QoL) has been one of the goals of health care for people living with oral cancer. This study aimed to assess QoL and investigate the effects of stigma, hope, and social support on QoL among Chinese oral cancer patients.MethodsA cross-sectional study was conducted at the Department of Stomatology, Shengjing Hospital of China Medical University and Stomatology Hospital of China Medical University in Liaoning Province, China, between May 2016 and October 2017. A total of 230 oral cancer patients were recruited to complete a questionnaire including the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), the Social Impact Scale (SIS), the Herth Hope Index (HHI) and the Multidimensional Scale of Perceived Social Support (MSPSS). Univariate one-way ANOVA/t-test, Person’s r and hierarchical linear regression analysis were conducted to explore the factors influencing QoL and the relationships between stigma, hope, perceived social support and QoL.ResultsThe mean QoL score was 90.85 ± 20.15 among the patients with oral cancer. Stigma was negatively related to QoL, explaining 39.3% of the variance. In addition, hope and perceived social support were positively associated with QoL, explaining 8.1% of the variance.ConclusionOverall, Chinese patients with oral cancer suffer from low QoL. Stigma was significantly and negatively associated with QoL, while hope and perceived social support were positively associated with QoL. Oral cancer patients’ psychological states should be addressed, and adequate intervention based on positive psychological resources should be provided to improve the QoL of patients with oral cancer.

Breaking Down Silos: Interprofessional Collaborative Practice in Humanitarian Audiology.

The goal of humanitarian healthcare is to improve health outcomes and patient quality of life in under-resourced areas. One avenue for improvement may be via interprofessional collaborative practice, which allows providers from multiple specialties to work together to promote positive interventions for the communities they serve. The purpose of this article is to provide a general framework for incorporating interprofessional collaborative practice within a humanitarian audiology project.

Beyond Resilience: A Concept Analysis of Human Flourishing in Adolescents and Young Adults With Cancer.

This article explores the concept of human flourishing in the context of adolescents and young adults with cancer, using Rodgers' Evolutionary Concept Analysis method. We describe flourishing in adolescents and young adults with cancer experience as a continuous and dynamic process of growth and maturity among intrapersonal, interpersonal, and person-environmental dimensions. Flourishing adolescents and young adults with cancer achieve internal integration, evoke positive changes in their environments, and ultimately create a harmonious and balanced existence with the outside world. Human flourishing can be a new health care goal that nurses can apply to this population.

Discrepancy in Ratings of Shared Decision Making Between Patients and Health Professionals: A Cross Sectional Study in Mental Health Care.

BackgroundA defined goal in mental health care is to increase the opportunities for patients to more actively participate in their treatment. This goal includes integrating aspects of user empowerment and shared decision-making (SDM) into treatment courses. To achieve this goal, more knowledge is needed about how patients and therapists perceive this integration.ObjectiveTo explore patient experiences of SDM, to describe differences between patient and therapist experiences, and to identify patient factors that might reduce SDM experiences for patients compared to the experiences of their therapists.MethodsThis cross-sectional study included 992 patients that had appointments with 267 therapists at Sørlandet Hospital, Division of Mental Health during a 1-week period. Both patients and therapists completed the CollaboRATE questionnaire, which was used to rate SDM experiences. Patients reported demographic and treatment-related information. Therapists provided clinical information.ResultsThe analysis included 953 patient-therapist responder pairs that completed the CollaboRATE questionnaire. The mean SDM score was 80.7 (SD 20.8) among patients, and 86.6 (SD 12.1) among therapists. Females and patients that did not use medication for mental health disorders reported higher SDM scores than males and patients that used psychiatric medications (83.3 vs. 77.7; p < 0.001 and 82.6 vs. 79.8; p = 0.03, respectively). Patients with diagnoses involving psychotic symptoms reported lower SDM scores than all the other patients (66.8 vs. 82.3; p < 0.001). The probability that a patient would report lower SDM scores than their therapist was highest among patients that received involuntary treatment (OR 3.2, p = 0.02), patients with treatment durations longer than 2.2 years (OR 1.9, p = 0.001), and patients that required day care or in-patient care (OR 3.2, p = 0.01 and OR 3.2, p < 0.001, respectively).ConclusionWe showed that both therapists and patients reported good SDM experiences in decisional situations, which indicated that SDM was implemented well. However, the SDM scores reported by in-patients and patients with prolonged or involuntary treatments were significantly lower than scores reported by their therapists. Our findings suggested that it remains a struggle in mental health care to establish a common understanding between patients and therapists in decisional processes regarding treatments for some patient groups.

Pressure Injuries in the Healthcare Setting

Background: The ultimate goal and purpose of healthcare is to improve health while preventing morbidity and mortality. The optimal approach to this is through teamwork using a reliability framework. Upon review of our institution’s 2012 patient safety culture survey data, we noted that the teamwork domain of the Agency for Healthcare Research and Quality (AHRQ) assessment was in the lowest decile. Our institution implemented the Crimson Analytics tool in 2013, and an analysis of inpatient mortality data revealed higher than expected mortality statistics. Objective: Hospital systems and team-based care are more developed during daytime hours, leaving patients more vulnerable to adverse events (morbidity and mortality) during the overnight period. Our objective was to develop optimal transitions of care and proactive risk identification/mitigation through an interprofessional team-based approach, with resultant decrease in patient harm and improvement in safety culture. Methods: In a community hospital, standardize transitions to identify “at risk” patients for nurses, physicians, and respiratory techs with subsequent interprofessional review of care plans/patient status in a centralized midevening standup briefing, subsequent proactive rounding on “at risk” patients, use of error prevention behaviors aimed to mitigate cognitive bias, and end-of-shift reflection process. Results: Inpatient mortality rates fell from a baseline level of 2.08% in April 2013–March 2015 to 1.56% during the intervention period from April 2015–March 2018. The observed/expected mortality ratio fell from 1.04 to 0.76. AHRQ safety culture data improved in the team-work domain from 81% to 83%. A custom survey for this intervention was developed and found significant improvements in risk awareness and mitigation response, teamwork, efficiency, and—potentially—joy at work. Conclusion: An interprofessional approach to high-quality transitions in care, risk identification, and mitigation, along with structured huddles and proactive rounding, can improve patient safety at night while simultaneously improving staff satisfaction, joy, and safety culture.

Create a Safe Night

Background: The ultimate goal and purpose of healthcare is to improve health while preventing morbidity and mortality. The optimal approach to this is through teamwork using a reliability framework. Upon review of our institution’s 2012 patient safety culture survey data, we noted that the teamwork domain of the Agency for Healthcare Research and Quality (AHRQ) assessment was in the lowest decile. Our institution implemented the Crimson Analytics tool in 2013, and an analysis of inpatient mortality data revealed higher than expected mortality statistics. Objective: Hospital systems and team-based care are more developed during daytime hours, leaving patients more vulnerable to adverse events (morbidity and mortality) during the overnight period. Our objective was to develop optimal transitions of care and proactive risk identification/mitigation through an interprofessional team-based approach, with resultant decrease in patient harm and improvement in safety culture. Methods: In a community hospital, standardize transitions to identify “at risk” patients for nurses, physicians, and respiratory techs with subsequent interprofessional review of care plans/patient status in a centralized midevening standup briefing, subsequent proactive rounding on “at risk” patients, use of error prevention behaviors aimed to mitigate cognitive bias, and end-of-shift reflection process. Results: Inpatient mortality rates fell from a baseline level of 2.08% in April 2013–March 2015 to 1.56% during the intervention period from April 2015–March 2018. The observed/expected mortality ratio fell from 1.04 to 0.76. AHRQ safety culture data improved in the teamwork domain from 81% to 83%. A custom survey for this intervention was developed and found significant improvements in risk awareness and mitigation response, teamwork, efficiency, and—potentially—joy at work. Conclusion: An interprofessional approach to high-quality transitions in care, risk identification, and mitigation, along with structured huddles and proactive rounding, can improve patient safety at night while simultaneously improving staff satisfaction, joy, and safety culture.

Feasibility and Acceptability of Using a Telehealth Platform to Monitor Cardiovascular Risk Factors in Hematopoietic Cell Transplantation Survivors at Risk for Cardiovascular Disease.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in hematopoietic cell transplantation (HCT) survivors. In these patients, such risk factors as hypertension, diabetes, obesity, and physical inactivity are important modifiers of CVD risk. However, the period when HCT survivors are at greatest risk of developing these risk factors, and in turn CVD, coincides with a drop in engagement in survivorship care. We examined the feasibility and acceptability of a 4-week remote risk-based monitoring (blood pressure monitor, weight scale, pulse oximeter, glucometer) and management program in 18 (11 allogeneic and 7 autologous) HCT survivors at intermediate-high risk of CVD. The median patient age was 66 years (range, 53 to 74 years), 67% had hypertension, 22% had diabetes, 11% were obese (body mass index ≥30 kg/m2), 56% were at intermediate risk of CVD, and 44% were at high risk of CVD. Weekly compliance with the remote monitoring schedule (≥3 readings/week using all devices) ranged from 72% in week 1 to 83% in weeks 2 to 4. Fifteen participants (83%) generated 86 alerts that were outside the predetermined range of normal; 63 of these readings (73%) normalized without intervention, and 23 (27%) necessitated triage by the study research nurse. Nearly all participants reported that the study kept them motivated and involved in their healthcare, and >85% agreed that the study supported their healthcare goals, helped them learn and manage their health conditions, and increased their access to healthcare. These findings may set the foundation for innovative risk-based and remote interventions to reduce the burden of CVD in this growing population of patients.

582 Bridging the Gap Between Inpatient and Outpatient Burn Care Compliance: Incentive Programs for Pediatric Burn Patients

Abstract Introduction As healthcare advances, treatment options are expanding to allow patients to be cared for in outpatient settings. To ensure quality of treatment is maintained, efforts must be made to translate resources offered during inpatient stays to the outpatient population. This is especially important for pediatric burn patients and their families whose treatment plan is contingent on maintaining critical aspects of care provided during the course of an admission. Optimal outcomes are dependent on patients complying with physical/occupational therapy activities, meeting increased nutritional standards, and performing daily dressing changes. Methods Incentive programs have traditionally been effective during hospital stays by rewarding children upon completion of difficult tasks, which encourages participation and provides a sense of control. In order to meet the needs of our patient population, a burn specific incentive program named “Burn Bucks” was developed with the intent to establish early patient engagement and goal setting. This program allows for a successful transition from inpatient to the home setting. Patients identify their most difficult healthcare goals and a dollar amount is assigned to that goal. Throughout their stay, staff give “bucks” for the completion of goals. As patients progress, goals are updated. Patients may use Burn Bucks earned to shop in the “Burn Bucks Store.” In preparation for discharge, home care goals are set for patients. Upon return to clinic, patients may shop in the Burn Bucks Store at the end of each appointment. Results Patients who participated in the Burn Bucks program returned as outpatients less fearful of the treatment room and more motivated to take an active role in their therapies. Preliminary data shows those who use burn bucks in the home setting are more likely to meet or surpass treatment goals. Additionally, parents and staff report increased participation as well as an improved overall demeanor by children who participate in the Burn Bucks program. Conclusions The Burn Bucks program has proven to be a successful tool to engage patients and families in their treatment plan. Early introduction during inpatient stays encourages participants to continue using Burn Bucks in the home setting. We continue to find ways to adapt the structure of the program to support various age groups and abilities, enhance coping, and individualize incentives to achieve optimal outcomes. Applicability of Research to Practice The success this program has brought to our patient population has prompted other teams within our hospital to adopt the Burn Bucks program to accommodate a variety of treatment plans. The ability for this particular incentive program to adapt to various treatment goals contributes to its consistent success. The principles of this program can be easily implemented in burn centers of any size.