Outpatient Education Research Articles

Three-week inpatient energy management education (IEME) for persons with multiple sclerosis-related fatigue: Feasibility of a randomized clinical trial

BackgroundMultiple sclerosis (MS)-related fatigue limits participation in everyday activities and has a considerable impact on quality of life (QoL), thereby affecting productivity and employment. Outpatient education interventions involving energy conservation strategies and cognitive behavioral therapy techniques are helpful. However, no inpatient program is currently available. The inpatient energy management education (IEME) program is a novel group-based intervention that lasts for 6.5 h and is conducted by a trained occupational therapist (OT) during a 3-week period of inpatient rehabilitation. Persons with MS (pwMS) and OTs previously evaluated the IEME positively in a pilot study test run. The aim of this study was to evaluate the feasibility of a research protocol and collect preliminary data on the IEME effect size. MethodsTo assess the feasibility of conducting a randomized clinical trial, pwMS-related fatigue were recruited during a 3-week inpatient rehabilitation. Six IEME (experimental) group sessions or progressive muscle relaxation (PMR, control) group sessions comprised part of a personalized rehabilitation program. The recruitment and assessment procedures, dropout and follow-up assessment rates and the treatment fidelity were evaluated, and six telephone interviews were conducted with IEME participants after they returned home. Outcomes were fatigue impact, occupational performance, self-efficacy regarding energy conservation strategies, and QoL at baseline, discharge, and 4 months. Paired-sample and independent-samples t-tests were used to assess within- and between-group effects. Effect sizes were estimated using Cohen's d. ResultsBetween August and November 2017, 47 pwMS were included and randomized. The dropout rate (4.2%) was low and the sample was balanced. The PMR was a well-accepted control intervention. The OTs reported no problems in conducting the IEME, and treatment fidelity was high. IEME participants confirmed the adequacy of the IEME. Within-group differences in fatigue impact and some QoL dimensions at discharge were significant (p < 0.05) in both groups. The IEME alone resulted in significant improvements in self-efficacy regarding energy conservation strategies, with a large effect size (Cohen's d: 1.32; 95% CI: 0.54–2.1), and in the QoL physical functioning dimension at T2 (Cohen's d: 1.32; 95% CI: 2.11–0.53). IEME participants spent significantly less time in individual OT sessions. A sample size of 192 participants in a randomized controlled trial would be sufficient to detect clinically relevant between-group differences. ConclusionThis feasibility study has provided promising preliminary data about the effect of the IEME. The research protocol was confirmed to be feasible and a future study is justified. This study was registered in the German Clinical Trials Register (no. DRKS00011634).

Dementia Care Across a Tertiary Care Health System: What Exists Now and What Needs to Change

ObjectivesThis study explored the process of care for persons living with dementia (PLWDs) in various care settings across a tertiary care system and considers challenges and opportunities for change. DesignAimed at quality improvement, qualitative interviews were conducted with key stakeholders in dementia care across geriatric outpatient clinics, medical and psychiatric emergency departments, and the main hospital in 2016. Setting and participantsForty-nine interactive interviews were conducted with a purposive and snowball sampling of health care professionals (physicians, nurses, social workers, administrators) and families in a large, academic health care system. MeasuresQualitative interview guides were developed by the study team to assess the process of care for PLWDs and strengths and challenges to delivering that care. ResultsKey themes emerging from the interviews in each care setting are presented. The outpatient setting offers expertise, a multidisciplinary clinic, and research opportunities, but needs to respond to long waitlists, space limitations, and lack of consensus about who owns dementia care. The emergency department offers a low nurse/patient ratio and expertise in acute medical problems, but experiences competing demands and staff turnover; additionally, dementia does not appear on medical records, which can impede care. The hospital offers consultative services and resources, yet the physical space is confined and chaotic; sitters and antipsychotics can be overused, and placement outside of the hospital for PLWDs can be a challenge. Conclusions and implicationsFive key recommendations are provided to help health systems proactively prepare for the coming boom of PLWD and their caregivers, including outpatient education, a dementia care management program to link services, Internet-based training for providers, and repurposing sitters as Elder Life specialists.

Is there a difference in the perception of outpatient clinic teaching, between medical students and teachers'? A mixed method study.

This article was migrated. The article was marked as recommended. Background: Outpatient clinic teachingis an important part of undergraduate medical student's experience. Increasing pressure from service commitments has meant that limitations to the learning process have continued to surface. Previous studies have looked at satisfaction level of all involved; however no studies have examined whether the limitations are perceived differently between students and teachers in a real life setting. Method: A mixed method project including on-line questionnaires, focus group and interviews with ninety two participants. This was conducted in a local university hospital. Teachers and students were asked about teaching styles undertaken and limitations during clinics. They were also asked about how to improve the learning process during outpatient clinics. Results: Teachers and students agree that seeing patients under supervision is the ideal teaching style during clinics. Both groups agree that time and space, are the obvious limitations to outpatient teaching. Advanced planning, however, and teachers' attitude toward teaching have also been rated highly from students' perspective. Conclusion: Common themes emerged between students and teachers regarding outpatient teaching. Reducing patient numbers seems the ideal solution. Given the increasing service demands in the current climate, it was perceived that improving communication before and after clinics between students and teachers who are interested in teaching could positively influence learning in this setting.

Empanelment in a Resident Teaching Practice: A Cornerstone to Improving Resident Outpatient Education and Patient Care.

Improving continuity is challenging in residency training practices. Studies have shown that empanelment enables high-performing primary care and is foundational to improve accountability and continuity. An empanelment process was created in a large, urban, residency training practice as an effective approach to enhancing continuity among residents and their patients. In 2016, we formed an empanelment committee that included stakeholders from the department of medicine, the internal medicine residency program, and hospital and IT leadership. This committee set goal panel sizes, selected an empanelment algorithm, determined which patients needed re-empanelment, and facilitated medical record integration. Empanelment was followed and reassessed quarterly for 2 years. We measured anticipated visit demand using visits in the prior year and continuity using the continuity for physician formula. Of 18 495 active patients in July 2016, 8411 (45%) were assigned a new PCP in the empanelment process. At baseline, panel sizes and expected visit demand were highly variable among residents (from 40 to 107 and 120 to 480, respectively). Empanelment led to more equivalent panel sizes and expected visit demand across same year residents (eg, PGY-3: 80-100 and 320-440, respectively). Continuity for all PCPs in the practice improved from 63% before empanelment to over 80% after empanelment, and improved from 55% to 72% for individual residents. In a large and complex practice environment, we were able to empanel resident clinic patients to improve continuity and maintain it over 2 years.

Determinates of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: cross-sectional study

BackgroundDepression and heart disease are an important public-health problem. Depression is one of the most prevalent and disabling psychiatric disorders with more than three times increased risk among patients with cardiovascular disorders.ObjectiveTo identify the prevalence and associated factors of depressive disorder among adult patients with cardiovascular disease.MethodsInstitution based cross-sectional study design was used to conduct this study on 293 study participants attending an outpatient cardiac clinic at Jimma University Teaching Hospital. All eligible patients were recruited into the study consecutively. Depression was assessed using patient health questionnaire-9. The patient health questionnaire-9 had a total score of 27, from which 0–4: no/minimal depression, 5–9: mild depression, 10–14: moderately depression, 15–19: moderately severe depression and 20–27 severe depression. The data was feed into Epi-data version 3.1 and lastly exported to SPSS version 21 for analysis. Bivariate analysis was used to analyze the statistical association of covariates of interest with depressive disorder among patients with cardiovascular disease. Then, logistic regression analysis was used as a final model to control confounders. The strength of association was measured by a 95% confidence interval.ResultsA total of 293 adult patients diagnosed with the cardiovascular disease were included in the study with 97% (n = 284) of response rate, 47.2% (n = 134) males and 52.8% (n = 150) females, making female to a male ratio around 1.1:1. The prevalence of depression was 52.8% (n = 150/284). Out of the subjects with depression 52.67% (n = 79), 36.0% (n = 54) and 11.33% (n = 17) were mild, moderate and severe depression, respectively. Variables such as employed, unemployed, physical activity, current cigarette user and poor social support were independently associated with depression in the final model.ConclusionsIn this study, depression was found to be highly prevalent psychiatric comorbidity in adult cardiovascular disease patients.

Application of formatted text message in follow-up improves treatment compliance of patients with hyperthyroidism

Eighty patients with hyperthyroidism treated in PLA 903 Hospital from February 2016 to May 2017 were randomly divided into two groups with 40 cases in each group. Patients in control group received routine outpatient education and those in study group received regular formatted mobile short message during follow-up in addition to routine education. The knowledge of disease, the compliance and satisfaction of treatment were assessed. After 12 weeks of follow-up, the TSH level was higher [0.430 (0.050, 2.806) vs.0.210 (0.003, 1.098) mU/L, Z=-8.07, P<0.01], FT3 [(3.24±1.18) vs.(4.18±2.07)ng/L, t=-2.49, P<0.05] and FT4 levels [(12.43±6.82) vs.(19.58±19.06) ng/L, t=-2.26, P<0.05] were lower in study group than those in control group. The scores of disease knowledge (6.12±1.77 vs. 5.25±1.79, t=4.67, P<0.05), the Morisky scores of medication compliance (3.77±0.47 vs. 3.37±0.73, t=8.22, P<0.01), the rates of compliance for returning (85% vs. 65%, χ2=4.27, P<0.05) and the satisfaction rates with treatments (93% vs. 75%, χ2=3.30, P<0.05) in the study group were significantly higher than those in the control group.The score of disease knowledge in study group increased from 4.32±1.55 before treatment to 6.12±1.77 after 12 weeks of follow-up (t=22.65, P<0.01) . The results indicate that the health education plus regular formatted text message during follow-up can effectively improve the disease knowledge score, the compliance and satisfaction with treatment in patients with hyperthyroidism. Key words: Health education; Short message, mobile; Hyperthyroidism; Medication adherence

A provider feedback intervention to increase uptake of colorectal cancer screening in a Swiss academic general practice

Colorectal cancer (CRC) cancer screening uptake is low in our diverse, outpatient teaching clinic. A state-level public screening programme was recently launched that provides faecal immunochemical tests or screening colonoscopy...

Measuring biopsychosocial risk for back pain disability in chiropractic patients using the STarT back screening tool: a cross-sectional survey

BackgroundThe Keele STarT Back Screening Tool (SBT), a 9-item questionnaire, screens for pain, physical functioning, fear-avoidance beliefs, catastrophizing, anxious thoughts, low mood, and bothersomeness in persons with back pain. SBT scores designate low, medium, or high risk for developing persistent disabling back pain. The primary study aim was to report the prevalence of SBT-calculated risk for back pain disability in US patients seeking chiropractic care.MethodsThe SBT questionnaire was administered to patients ≥18 years in 3 Chiropractic College outpatient teaching clinics in Iowa and Illinois (May 2017). Descriptive statistics were used to analyze respondent characteristics and prevalence of SBT-calculated risk subgroups. Binary logistic regression analysis was used to examine the relationship between respondent characteristics and SBT scores (including psychological subscores).ResultsOf 550 respondents, 496 completed the SBT; 392 (79%) scored low-risk, 81 (16%) medium-risk, and 23 (5%) high-risk. Mean (SD) age was 44.8 (15.9), 56.9% were female, 88.2% white, 62.6% employed, mean current pain was 2.9 (2.1) out of 10, and 62% reported symptom duration > 3 months. Eighteen percent of respondents reported anxious thoughts, 32% low mood, 41% ≥ 1 and 21% ≥ 3 SBT psychological risk factors. Respondents reporting higher average pain (OR = 1.8 [1.4, 2.3]) and pain severity (OR = 1.3 [1.0 to 1.6]) were more likely to score with medium or high risk. Respondents reporting mid back versus low back pain (OR = 0.2 [0.1, 0.7]), and those employed less than full-time versus full-time (0.2 [01, 0.5]) were less likely to score with medium or high risk. Respondents reporting higher average pain were more likely to report ≥1 psychological factor (OR = 1.8 [1.5, 2.0]). Respondents employed part-time were less likely to report ≥1 psychological factor than those employed full-time (OR = 0.4 [0.2, 0.7]).ConclusionThe sample surveyed was less likely to score with medium or high risk for back pain disability than previous samples studied, perhaps due to differences in study design and sample characteristics. Rates of low mood and anxious thoughts indicate a need for future research to explore psychological factors among persons seeking chiropractic care.

Education via WeChat improves glucose control and pregnant outcomes in women with gestational diabetes mellitus

Objective To evaluate the effect of strengthening nutrition intervention in gravidas with gestational diabetes mellitus (GDM) with WeChat on blood glucose control and pregnant outcomes. Methods A total of 410 gravidas, diagnosed with GDM and treated in the Department of Clinical Nutrition of Shanghai General Hospital from October 2015 to April 2016, were enrolled and randomly divided into two groups (n=205). The control group received traditional nutrition clinic education only, while the intervention group was given strengthened nutrition education through WeChat in addition to traditional education. Blood glucose level and insulin dosage were followed up after one, two and four weeks of intervention. Pregnant outcomes and patient satisfaction were investigated on 42 d after delivery. T test, Chi-square test and non-parametric test were used for statistical analysis. Results (1) Two weeks after the intervention, the average 1-hour postprandial blood glucose in the intervention group was lower than in the control group [(7.46±1.01) vs (7.68±1.06) mmol/L, t=2.243, P=0.025]. After 4 weeks, both 1- and 2-hour postprandial blood glucose levels of the intervention group were lower than those of the control group [(7.03±0.65) vs (7.33±0.63) mmol/L, t=4.629, P<0.05; (6.00±0.65) vs (6.21±0.62) mmol/L, t=3.153, P<0.05] and more gravidas achieved euglycemia [79.9% (151/189) vs 60.8% (113/186), χ2=16.483, P<0.001]. (2) Compared with the control group, the intervention group had a higher vaginal delivery rate [38.7% (72/186) vs 50.5% (95/188), χ2=5.288, P=0.021] and a lower rate of postpartum complications [9.1% (17/186) vs 2.1% (4/188), χ2=7.394, P=0.007]. All of the gravidas in the intervention group were satisfied with the WeChat intervention except one lost to follow up [99.5% (203/204)]. Conclusions Strengthening nutrition education through WeChat is much more effective than traditional nutritional outpatient education alone in order to achieve a better control of blood glucose and improve pregnant outcomes in GDM women. This intervention is highly acceptable to gravidas and can be further extensively applied in nutrition clinic. Key words: Diabetes, gestational; Blood glucose; Pregnancy outcome; Social media; Patient education as topic

The Educational and Clinical Benefits of a “Consultant-Speciality Trainee” ENT Shared Clinic

Introduction and Aims. The European Working Time Regulations (EWTR) of 48-hour working week limit have raised concerns regarding the quality of medical training for junior doctors. Our study has looked to improve junior doctors training without impairing patients’ care with the introduction of one-to-one “consultant with specialty trainee” doctor teaching in the outpatient clinic setting. Methodology. In this study, an ENT specialty trainee conducted a 3-month block of solo clinics seeing new patients. After that, the same specialty trainee shared the clinic with an ENT consultant for 3 months and subsequently the same trainee reconducted solo clinics. Outcomes of the specialty trainee performance were measured clinically by completed patient episodes (CPE) (i.e., patient discharged from clinic or placed on surgical operation waiting list) and ongoing patient episodes (OPE) (i.e., patient given follow-up appointment to ENT clinic) and educationally by workplace based assessments (WBA) completed in the trainee’s e-portfolio. Results. 271 patients were recruited in this research: 24% being in the preintervention group, 47% during the intervention, and 29% in the postintervention. The intervention of one-to-one outpatient clinic teaching increased the specialty trainees CPE rate (60% to 67.5%, p&gt;0.1) and reduced their OPE rate (40% to 32.5%, p=0.001). Educationally these trainees completed with the consultant statistically significant WBA (17 assessments) during the one-to-one clinics compared to solo clinics (2.3 on average). Discussion and Conclusion. In this study, a positive trend in the clinical outcomes was obtained in terms of CPE, while a statistically significant reduction of the total OPE was achieved giving an indicator to consider this concept for further research in terms of patient’s clinical outcomes. Nevertheless, it showed a new way of supporting the trainee’s education supported by more WBA being filled.

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.

The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2

ObjectiveThe purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus. MethodsPatients were randomly assigned to education group and control group. Education group received professional education and control group received routine outpatient education. ResultsA total of 118 patients were randomly assigned to two groups (education group, n = 63; control group, n = 55). Compared with control group, the anxiety score (36.00 vs. 42.50, P < 0.05) and depression score (35.50 vs. 44.00, P < 0.05) significantly decreased at the sixth month in education group, respectively. Compared with control group, fasting blood glucose (6.78 mmol/L vs. 7.70 mmol/L, P < 0.00), postprandial blood glucose (7.90 mmol/L vs. 10.58 mmol/L, P < 0.00) and glycosylated haemoglobin A1C level [6.20 (5.80, 6.60)% vs. 6.70 (6.40, 7.30)%, P < 0.01] significantly decreased after the sixth month in education group. ConclusionThe psychological status and blood glucose of patients with diabetes receiving self-management education were significantly improved. Practice Implications: Type 2 diabetes mellitus has been usually linked to increased prevalence and risk of depression and anxiety, which can affect blood glucose levels. Through education, the mood of newly diagnosed patients with diabetes improved, resulting in better blood glucose control.

OP86 Outpatient Initial Management Of New-Onset Diabetes In Children

Introduction:Management of new-onset diabetes is important to achieve metabolic stabilization, minimize acute complications, and to provide insulin therapy, diabetes education and psychological support. A health technology assessment (HTA) was conducted to determine if an outpatient setting could be effective and safe for new-onset diabetes in children, and how it can be implemented in our pediatric center.Methods:A systematic search on initial management (outpatient versus in-hospital) of diabetes in children was performed in multiple databases and grey literature. Practice guidelines (CPGs), systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) published up to August 2017 were identified. Telephone interviews with key informants from two children's university teaching hospitals were performed to collect information on outpatient initial management models and issues related to their implementation. An interdisciplinary group of experts from our pediatric center collaborated in this project.Results:According to 5 CPGs, hospitalization would not be required for children without acute complications at time of diagnosis or after initial treatment of ketoacidosis if outpatient care facilities, resources, and education are available. Results from one SR and 7 NRCSs suggested that outpatient initial management is associated with good metabolic control (glycated hemoglobin) and is as safe as the inpatient care model, based on rate of hospital admissions, severe hypoglycemia, and ketoacidosis episode. However, few data regarding treatment adherence, knowledge acquisition, and emotional adaptation were identified. Outpatient education programs can be successfully provided on several consecutive or non-consecutive days after diagnosis as reported by two children's university teaching hospitals.Conclusions:Although data on effectiveness and safety are scarce and of low-quality, outpatient management of newly diagnosed diabetes, uncomplicated or stabilized, is recommended in children. However, data on children and their families should be collected as part of the implementation evaluation in order to enhance its efficacy and the quality of the patients’ and families’ experiences.

120 years of outpatient service and ambulatory education in Moscow

120 years of outpatient service and ambulatory education in Moscow

Impact of a one-minute preceptor on learning of pulmonary medicine postgraduates: Perceptions and review of literature

Context: Clinical reasoning and patient management skills are integral part of postgraduate (PG) medical education. Often, traditional teaching practices and paucity of time hinder this aspect of a resident's development. One-minute preceptor (OMP) is a learner-centered model that might improve PG learning. Aims: The study was conducted to introduce OMP as an educational tool for pulmonary medicine PG students and to evaluate the perceptions of residents and faculty on its utility. Subjects and Methods: Thirteen pulmonary medicine PG residents and six faculty members participated in this study. After initial sensitization about the teaching tool, thirty OMP sessions were conducted in the outpatient department with each resident undergoing a minimum of two sessions. Resident and faculty perceptions on this process were evaluated through validated questionnaires that were graded on a Likert scale. Results: All 13 residents perceived that OMP can improve their clinical reasoning skills as well as increase their motivation for further study (average Likert score for both: 4.69 + 0.48). However, 53.8% (n = 7) of residents perceived that the time devoted to OMP session was inadequate. Faculty also perceived that OMP was an effective teaching method and advocated its routine use in PG teaching. Conclusion: Both residents and faculty perceived OMP as an effective teaching tool in outpatient teaching of PG residents.

Application of GP-IP teaching model in general practice residency training

The unique concept, characteristics and service contents of general practice make its residency training to focus on outpatient teaching. General Practitioner Inquiry-Preceptor (GP-IP) is an outpatient teaching mode developed in the general practice residency training base of our hospital. The GP-IP teaching mode includes four modules: diagnosis and treatment package for medically unexplained physical symptoms, Pendleton and RICE inquiry model, video teaching and problem based learning. Key words: General practitioners; Teaching methods

Outpatient Education: An Overlooked Concern in Iran

Outpatient Education: An Overlooked Concern in Iran

238 - Lessons learned from Heart Failure Bundle Payment Care Improvement: Post-acute Care Focus

Introduction: HF is a chronic disease that affects nearly 6 million people and accounts for one million hospitalizations in the US annually. It is the leading cause of hospitalizations in adults >65 with costs accounting for 17% of overall national health expenditures. CMS, under the Patient Protection and Affordable Care Act, developed disease specific models of care for clinical & financial improvements, termed Bundled Payment for Care Improvement Initiatives (BPCI). This facility chose participation in Model 2 BPCI for HF. This is a 90-day episode of care in which target prices were determined by previous 2-year costs with a build-in 2% reduction. The BPCI payment is determined by primary discharge DRG and participation in Medicare A & B. Episodic reconciliation takes place quarterly with positive or negative payments made annually. Methods: Our center entered into a 90-day BPCI program October 2015, a total of 104 episodes qualified under guidelines for participation between October 1, 2015 and June 30, 2016. During evaluation & implementation of care design, focus was given to care coordination and interdisciplinary communication. Data was gathered and disseminated per CMS utilizing Business Objects methodology. Results: Pre-care redesign, post-acute facility usage averaged 40%, with a decrease to 35% after implementation. Average LOS was 36 days pre-bundle to 16 days post-implementation. In this region, the average cost per day for a skilled nursing facility is $350. By decreasing the average LOS by 20 days, a savings of~$7000 is achieved. The pre-BPCI readmission rate was 35.6%. As a result of care coordination and interdisciplinary communication, readmission rate was reduced to 25.5%, with local readmission costs ranging $3,500.00–$17,000. Conclusion: Two primary quality and cost drivers that will “make or break” an Episode Payment Model (EPM) during the post-acute care period 1~post-acute facility practices 2~readmissions. Post-acute facility practice improvement efforts focused on coordinated care from anchor site with facility to decrease LOS by forming a Continuing Care Network (CCN) and increased facility utilization by the anchor site. A certification course offering CME was developed for post-acute facilities to improve patient care and coordination. Readmission rates were decreased by improved structured coordination, access to urgent care clinics through PCP or HF program and education. Our site developed a HF clinic with same day evaluations to provide care for any reason that may otherwise cause a trip to the ER or readmission. Furthermore, the development of the “Heart Failure Academy” provided outpatient education at our site for patients & caregivers. With lessons learned from BPCI implementation, a site can successfully improve the quality of care, patient satisfaction and decrease overall cost of care significantly.

230 - Heart Failure Academy: Outpatient, Non-clinical Education Class that Reduces Readmissions and Improves Self-care

HF is a chronic disease that affects nearly 6 million people and one million hospitalizations in US annually. It is the leading cause of hospitalizations in adults >65, high burden of health care costs and one of the highest rates for readmissions. Education provided to patients regarding this chronic disease has been shown to be helpful, with studies showing trends toward lower all-cause mortality, length of stay, hospital costs and improvement of quality of life scores. However, research has shown that education concentrated during inpatient stay is retained in only 30% of patients. There is rising interest for alternative educational program formats to implement at centers across the US. Our site developed a focused, outpatient education program for people with HF and their family/caregivers called the “Heart Failure Academy (HFA)”. This promoted wellness & health decisions as well as increased specific understanding of HF & self-care management. Method: HFA is a disease specific educational class provided in an outpatient, non-clinical setting to patients and caregivers. A 2.5 hour session was provided at the site of hospitalization which focused disease management, self-care and community resource identification. Participants were identified during hospitalization and provided information on the course. HF clinic visits also emphasized participation and benefit to patient and caregivers. Participants were encouraged to 1-Bring a family member or support person 2-Identify additional questions/issues to discuss with physician 3-Identify at least one health practice that they could commit to improve their health & quality of life. Course was developed with inter-disciplinary approach lead by a dedicated RN. Support provided by pharmacy, cardiac rehabilitation, dietician, palliative care, exercise physiologist, community social services and mental health. Results: From October 2015-May 2016, The HFA had 65 patients & 44 family members attend and complete the session. There was a reduction in HF readmissions from 15.2 to 12.5/month since initiating HFA. A survey was implemented post-session to assess understanding and benefits. Results showed that 94% reported HFA was “beneficial” or “very beneficial” to their health, 6% reported HFA identified questions they now want to ask their physician about their health, 86% identified at least 1 community resource they plan to use and 74% identified at least 1 health practice change. Conclusion: Results demonstrate this supportive-educational intervention can have an improvement in the participant's level of understanding of their disease process and appears to decrease readmission rates. The HFA appears to also empower patients to ask questions, discuss issues and become an active participant within their health care team. Allowing and encouraging the participation of family and care givers has also shown to be beneficial. Further studies are needed to evaluate the ability to retain education and improve outcomes.

Impact of Live Patient Didactic Conference on Neurology Resident Outpatient Education (P1.043)

Impact of Live Patient Didactic Conference on Neurology Resident Outpatient Education (P1.043)