Patient-centered Medical Care Research Articles

Consensus statements for the establishment of medical intensive care in low-resource settings: international study using modified Delphi methodology

BackgroundThe inadequacy of intensive care medicine in low-resource settings (LRS) has become significantly more visible after the COVID-19 pandemic. Recommendations for establishing medical critical care are scarce and rarely include expert clinicians from LRS.MethodsIn December 2023, the National Association of Intensivists from Bosnia and Herzegovina organized a hybrid international conference on the topic of organizational structure of medical critical care in LRS. The conference proceedings and literature review informed expert statements across several domains. Following the conference, the statements were distributed via an online survey to conference participants and their wider professional network using a modified Delphi methodology. An agreement of ≥ 80% was required to reach a consensus on a statement.ResultsOut of the 48 invited clinicians, 43 agreed to participate. The study participants came from 20 countries and included clinician representatives from different base specialties and health authorities. After the two rounds, consensus was reached for 13 out of 16 statements across 3 domains: organizational structure, staffing, and education. The participants favored multispecialty medical intensive care units run by a medical team with formal intensive care training. Recognition and support by health care authorities was deemed critical and the panel underscored the important roles of professional organizations, clinician educators trained in high-income countries, and novel technologies such as tele-medicine and tele-education.ConclusionDelphi process identified a set of consensus-based statements on how to create a sustainable patient-centered medical intensive care in LRS.

Fostering Empathy: Nurturing Compassionate Healers through Innovative Teaching and Insightful Assessment in Medical Education

Abstract: The significance of empathy in the realm of medical education cannot be undermined, as once a student embarks on their journey to serve and heal mankind, cultivating empathetic skills becomes an indispensable part of their training. Empathy plays a significant role in healthcare delivery in the domains of patient outcomes and doctor-patient relationships. This article provides a brief review of empathy education and assessment techniques in the field of medicine. Upon realizing the merits that can be attributed to empathy, it is of paramount importance that medical students must be trained in empathy to transform them into patient-centered healthcare professionals. Only training medical students in empathy will not serve the purpose, and we must complement the training component with assessment. In conclusion, empathy is one of the key components of compassionate and patient-centered medical care. This calls for the need to train and assess medical students during their training period to improve their empathetic abilities and support the process of producing competent and compassionate future medical doctors.

Cultural Competency Training in Medical Education: Adopting a Multipronged Approach to Overcome Challenges

Abstract The domain of cultural competency in medical education deals with the varied cultural backgrounds and specific needs of different patients who are accessing health-care delivery services. The training in cultural competency imparted to medical students augments their knowledge and makes them aware of the presence and role of cultural, ethnic, and socioeconomic diversity in heterogeneous population groups. It is quite essential that training of medical students to become culturally competent must be conducted across all professional years of training in a longitudinal manner. Even though there are multiple benefits of training medical students in the domain of cultural competency, once we plan and implement such training, there can be multiple challenges. In conclusion, as medical education continues to evolve to meet the health-related needs of diverse population groups, cultural competency has to be acknowledged as one of the foundational pillars in empowering future cohorts of health-care professionals to deliver inclusive and culturally sensitive patient-centered medical care. The need of the hour is to identify the potential challenges in its successful implementation and then adopt a multipronged approach to effectively respond to them.

Patient-physician interaction education in Korea: a systematic review.

Patient-physician interaction (PPI) is an important area in medical education, but in-depth discussions on the content of the outcome of patient-doctor education are rare. Therefore, in this study, we will systematically analyze the research on PPI education in Korea. In this study, papers searched with keywords related to PPI education from Korea's academic journal service were targeted according to a systematic literature analysis method. The scope of the study was to include papers published in academic journals that are candidates for Korea Citation Index registration, excluding dissertations, research reports, posters, conference presentations, books, and internet materials. The content included papers targeting medical education and medical school students was set as the range. As a result of the analysis, although communication between PPI has many positive effects in the PPI in medical education at medical schools, obstacles do occur, and various ways to overcome them were suggested. Therefore, although medical interview training between patients and doctors in medical schools is necessary, it was analyzed as being based on overseas research or lacking in specific content. The core of PPI education appears to be medical interviews, and it seems necessary to discuss whether empathy or patient-centered medical care are appropriate as the main principles of PPI education in Korea. Therefore, education on the patient-doctor relationship is an important element in medical humanities and medical humanities education, and it is expected that research and education on this will progress more actively.

Bioética clínica, deliberação e digitalização da medicina

Abstract The development of cognitive technologies and the robotization in health care may intensify the relational distance between healthcare professionals and patients. Therefore, bioethical reflection is essential to find the most appropriate means to integrate the benefits of digital technologies into health care, ensuring ethical care. Thus, bioethics provides healthcare professionals and patients with discursive resources, aiming to enable the most prudent and reasonable decision-making. The exercise of communicative competence is crucial in the process of digitalizing medical activities and in the use of data analysis through artificial intelligence. Deliberative practice and patient-centered medical care are the ethical directives for the introduction of computational technology in medicine, preserving humanized and dialogical health care.

Identifying and addressing social determinants of health to improve patient-centered care.

The purpose of this clinical improvement project was to instill a streamlined process of identifying social determinants of health (SDOH) in our clinic's diverse patient population and provide resources that address these barriers to health and well-being. At each clinic visit, patients self-identified SDOH through an easy-to-use Social Assessment Form. Using an online database, Community Relay (CR), providers had access to location-based community resources. In addition to accomplishing the above-mentioned goals, we were left with a more well-rounded understanding of our patients. Unique struggles were identified and barriers to care were revealed, allowing for more patient-centered medical care.

Malnutrition-related mortality trends in older adults in the United States from 1999 to 2020

BackgroundMalnutrition mortality in older adults is underrepresented in scientific literature. This obscures any recent changes and hinders needed social change. This study aims to assess malnutrition mortality trends in older adults (≥ 65 years old) from 1999 to 2020 in the United States (U.S.).MethodsMortality data from the Centers for Disease Control and Prevention’s (CDC) Wide-Ranging Online Data for Epidemiology Research (WONDER) database were extracted. The ICD-10 Codes E40 – E46 were used to identify malnutrition deaths. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) were extracted by gender, age, race, census region, and urban–rural classification. Joinpoint regression analysis was used to calculate annual percentage changes (APC) of AAMR by the permutation test and the parametric method was used to calculate 95% confidence intervals. Average Annual Percentage Changes (AAPC) were calculated as the weighted average of APCs.ResultsBetween 1999 and 2020, 93,244 older adults died from malnutrition. Malnutrition AAMR increased from 10.7 per 100,000 in 1999 to 25.0 per 100,000 in 2020. The mortality trend declined from 1999 to 2006 (APC = –8.8; 95% CI: –10.0, –7.5), plateaued till 2013, then began to rise from 2013 to 2020 with an APC of 22.4 (95% CI: 21.3, 23.5) and an overall AAPC of 3.9 (95% CI: 3.1, 4.7). Persons ≥ 85 years of age, females, Non-Hispanic Whites, residents of the West region of the U.S., and urban areas had the highest AAPCs in their respective groups.ConclusionDespite some initial decrements in malnutrition mortality among older adults in the U.S., the uptrend from 2013 to 2020 nullified all established progress. The end result is that malnutrition mortality rates represent a historical high. The burden of the mortality uptrends disproportionately affected certain demographics, namely persons ≥ 85 years of age, females, Non-Hispanic Whites, those living in the West region of the U.S., and urban areas. Effective interventions are strongly needed. Such interventions should aim to ensure food security and early detection and remedy of malnutrition among older adults through stronger government-funded programs and social support systems, increased funding for nursing homes, and more cohesive patient-centered medical care.

Overweight and obesity in adults: general principles of treatment and conservative management

The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by amultidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for astructured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.

An opponent model for agent-based shared decision-making via a genetic algorithm.

Shared decision-making (SDM) has received a great deal of attention as an effective way to achieve patient-centered medical care. SDM aims to bring doctors and patients together to develop treatment plans through negotiation. However, time pressure and subjective factors such as medical illiteracy and inadequate communication skills prevent doctors and patients from accurately expressing and obtaining their opponent's preferences. This problem leads to SDM being in an incomplete information environment, which significantly reduces the efficiency of the negotiation and even leads to failure. In this study, we integrated a negotiation strategy that predicts opponent preference using a genetic algorithm with an SDM auto-negotiation model constructed based on fuzzy constraints, thereby enhancing the effectiveness of SDM by addressing the problems posed by incomplete information environments and rapidly generating treatment plans with high mutual satisfaction. A variety of negotiation scenarios are simulated in experiments and the proposed model is compared with other excellent negotiation models. The results indicated that the proposed model better adapts to multivariate scenarios and maintains higher mutual satisfaction. The agent negotiation framework supports SDM participants in accessing treatment plans that fit individual preferences, thereby increasing treatment satisfaction. Adding GA opponent preference prediction to the SDM negotiation framework can effectively improve negotiation performance in incomplete information environments.

Применение информационных технологий в оценке качества оказания медицинской помощи

The currently relevant value-based healthcare model (Value-Based Healthcare) is more focused on ensuring long-term effectiveness and patient satisfaction, which is directly related to the implementation of the principles of patient-oriented and patient-centered activities [1]. In accordance with the Proposals (practical recommendations) on the organization of internal quality control and safety of medical activities in a medical organization (hospital) of the Federal State Budgetary Institution “National Institute of Quality” of Roszdravnadzor, compliance with the principles of patient-centered medical care provides for the development and implementation at the level of a medical organization of a patient safety strategy, including compliance with ethical standards and rules in the implementation of medical care activities. This also includes the procedure for organizing feedback with patients [15]. The use of information technologies in patient questionnaires and analysis of results allows for operational monitoring of patient satisfaction indicators and to create a basis for assessing most aspects of hospital activities from the perspective of patients: the quality of medical services and their results, interaction with staff, infrastructure and service components. The purpose of the study is to provide the results of the implementation of the author’s information and analytical system for collecting and processing information about patient satisfaction through an electronic web questionnaire and providing the calculation of satisfaction indicators in a multidisciplinary hospital. M a t e r i a l s a n d m e t h o d s . The basis of the study was a multidisciplinary hospital of the state budgetary healthcare institution “Regional Clinical Hospital No. 2” in Vladivostok. Within the framework of the study, the inpatient patients were surveyed using questionnaires in electronic form prepared by a medical organization, an information and analytical system was developed to conduct a mathematical analysis of the results of the survey according to five criteria for assessing the quality of medical care conditions. The study used a questionnaire including 20 questions, the answers to which express the opinion of patients about the quality of work of doctors and nursing staff, the comfort of the conditions of stay in the emergency department, as well as in the hospital during hospitalization. The questionnaire was developed in 2015, and for many years the survey was conducted using paper and manual calculations. But since 2021, patient questionnaires and analysis of the collected data have been transferred to an electronic format. In this article we present the results obtained with the help of an information system for collecting and analyzing questionnaires, in which adult patients of a round-the-clock hospital participated. R e s u l t s . The use of information technologies in patient questionnaires and analysis of results allows for operational monitoring of patient satisfaction indicators and to create a basis for assessing a number of aspects of hospital activity from the perspective of patients: the quality of medical services and their results, interaction with staff, infrastructure and service components make it possible to evaluate the effectiveness of measures to ensure comfortable conditions for the patient’s stay and can be used in practical healthcare to organize measures to eliminate defects and make decisions on the management of a medical organization. C o n c l u s i o n s . The introduction of additional methods for studying patient satisfaction using electronic forms, taking into account the specifics of the work of a medical organization to the requirements established by the Ministry of Health of the Russian Federation, makes it possible to increase the effectiveness of interaction with patients and can be one of the tools for assessing the social effectiveness of a medical organization (hospital).

Advances in patient-centered medical care for the management of obstructive sleep apnea

阻塞性睡眠呼吸暂停（OSA）是一种慢性疾病，治疗依从性差，需要长期管理。以OSA患者为中心的医疗照护是一种有效的个体化治疗模式。本文总结了以患者为中心的医疗在OSA诊断和治疗中的最新进展，以指导临床实践，包括了解患者对OSA诊断治疗的价值观、偏好、信念和健康素养，与患者进行共同决策，加强对患者教育和支持，并促进患者和家属参与OSA的诊治和自我监控，优化OSA诊疗的连续性和医疗可及性，从而减少并发症，提高医疗满意度。.

Evaluation of the Value of Chemotherapy

A pharmacist is "a person prepared to formulate, dispense, and provide clinical information on drugs or medications to health professionals and patients." A pharmacist is one member of the health care team, and he/she plays a key role in providing quality health and pharmaceutical care to the public. Health-related quality of life (HRQoL) is a useful indicator of a patients' overall health, and it can be estimated by questionnaire survey as patient-reported outcome. The development of an innovative method that extracts HRQoL data from compounding information from pharmacies and pharmacy department in hospital may be useful for a patient-centered medical care. In the near future, pharmacists will have to demonstrate their ability to create value for drug therapy by collecting HRQoL information that corresponds to the national policy of cost-effectiveness. In particular, evaluation of the value of chemotherapy is a problem involving education, clinical techniques, and society, so all pharmacists should work on this as a national topic.

Using medical expenditure panel survey data to explore the relationship between patient-centered medical homes and racial disparities in severe maternal morbidity outcomes.

There are persistent racial/ethnic disparities in the occurrence of severe maternal morbidity. Patient-centered medical home care has the potential to address disparities in maternal outcomes. To examine (1) the association between receiving patient-centered medical home care and severe maternal morbidity outcomes and (2) the interaction of race/ethnicity on patient-centered medical home status and severe maternal morbidity. Using 2007 to 2016 data from the Medical Expenditures Panel Survey, we conducted a cross-sectional study to estimate the association between receipt of care from a patient-centered medical home and the occurrence of severe maternal morbidity, and racial-specific (White, Black, Asian, Other) relative risks of severe maternal morbidity. Our study used race as a proxy measure for exposure racism. We identified mothers (⩾15 years) who gave birth during the study period. We identified patient-centered medical home qualities using 11 Medical Expenditures Panel Survey questions and severe maternal morbidities using medical claims, and calculated generalized estimating equation models to estimate odds ratios of severe maternal morbidity and 95% confidence intervals. Among all mothers who gave birth (N = 2801; representing 5,362,782 US lives), only 25% received some exposure patient-centered medical home care. Two percent experienced severe maternal morbidity, and this did not differ statistically (p = 0.11) by patient-centered medical home status. However, our findings suggest a 85% decrease in the risk of severe maternal morbidity among mothers who were defined as always attending a patient-centered medical home (odds ratios: 0.15; 95% confidence interval:0.01-1.87; p = 0.14) and no difference in the risk of severe maternal morbidity among mothers who were defined as sometimes attending a patient-centered medical home (odds ratios: 1.00; 95% confidence interval:0.16-6.42; p = 1.00). There was no overall interaction effect in the model between race and patient-centered medical home groups (p = 0.82), or ethnicity and patient-centered medical home groups (p = 0.62) on the severe maternal morbidity outcome. While the rate of severe maternal morbidity was similar to US rates, few mothers received care from a patient-centered medical home which may be due to underreporting. Future research should further investigate the potential for patient-centered medical home-based care to reduce odds of severe maternal morbidity across racial/ethnic groups.

Collection of patient-generated health data with a mobile application and transfer to hospital information system via QR codes

Background and ObjectiveThe collection of patient-generated health data (PGHD) is important for understanding a patient's daily status for efficient treatment. Mobile applications are effective for continuously collecting patient data, and it is desirable to promptly integrate such data into electronic medical records. However, most hospital information systems have limited connections with external mobile applications. Therefore, in this study, we developed a simple system that can collect data from patients with inflammatory bowel disease (IBD) and transfer the data to electronic medical records without a direct connection to a hospital information system. MethodsWe developed patient-facing mobile applications and physician-facing user-defined form templates for the hospital information system. The PGHD were transferred via QR codes using a two-way linkage. The persistence rates were measured and analyzed to clarify the factors affecting the continuous usage of the application. ResultsA mobile application connected to a hospital information system was implemented and used in on-site operations. Among patients with IBD using this application, 84.6%–91.7% continued to use it over six months and 72.2%–84.5% continued for over one year. Particularly, patients who used the application during the first two visits tended to be significantly frequent users. ConclusionsWe developed a mobile application connected to a hospital information system using a QR code, which is a simple way to continuously collect data from patients and enables physicians to use the data efficiently for patient-centered medical care.

PATIENT-CENTERED CARE AND SELF-MANAGEMENT: OPINION OF MILITARY PERSONNEL WITH CORONARY ARTERY DISEASE.

The aim: Тo determin attitude of military personnel with coronary artery disease to implementation of the principles of patient- centered care and self-assessment of adherence to treatment. Materials and methods: 72 military personnel (male aged 30-58 years) with coronary artery disease, who visited the general practitioners at the Outpatient Care Clinic of the National Military Medical Clinical «Main Military Clinical Hospital» were interviewed anonymously, using the specially designed questionnaire. The patients were divided into two groups: the 1st group with individuals of 49 years old and younger (39 military personnel, mean age 42,8«5,0) and the 2nd group who is 50 years and older (33 military personnel, mean age 53,2«2,4 years). Results: The results of a sociological survey showed that the majority of military personnel with coronary artery disease believe that doctors do not always provide them with enough information about their health (61,1%) and they do not always provide emotional support to solve their health problems (66,7 %). It has been indicated a mismatch between patients' willingness to participate in shared decision-making regarding a treatment (84,7 % of them) and adher¬ence to treatment - 55,6% of surveyed patients rated adherence to treatment by three points or less on a five-point scale. There is no statistically significant difference between military personnel of the 1st and 2nd groups. Conclusions: The results of the study showed the interest and readiness of surveyed military personnel with coronary artery disease to implementation of the principles of patient-centered medical care.

Digital health: The next evolution of healthcare delivery.

:Healthcare delivery models have evolved from fee-for-service to incentivized care like patient-centered medical homes and accountable care organizations. This article discusses the evolution of healthcare delivery models and presents a vision for digital health.

Difficult Conversations.

Difficult Conversations.

Palliative Care for Patients With Cancer and Kidney Disease.

Patients with cancer and kidney disease experience a range of symptoms that impact their quality of life. Pain, fatigue, decreased appetite, and depression are all common in this population. Kidney palliative care is patient-centered medical care focused on reducing symptoms and defining individualized goals of care for patients and their families. Pharmacologic management of pain in patients with cancer and kidney disease requires recognition of the type of pain, its cause, and the risks and benefits of different medication classes. This review describes basic symptom management options as well as considerations for discussing goals of care, prognosis, and end of life.

A medical home for children in foster care reduces expenditures

ABSTRACT Children in foster care are at risk from fragmented care, delayed access, medical complexity, and increased mental health needs. We studied health care expenditures for children in foster care managed by a Patient-Centered Medical Home foster care specialty clinic (Fresh Start). We used Alabama Medicaid claims data from 2016 to 2018 to compare the costs incurred by 75 pediatric patients managed by Fresh Start with 75 matched children in foster care. Compared to their matched controls, the average total expenditures of Fresh Start children were lower by $536 (p = .02, 95% CI [−1008, −63]), primary care expenditures were lower by $171 (p = .09, 95% CI [−371, 28]), and pharmacy expenditures were lower by $63 (p = .02, IQR = 598). Reduced expenditures identified among children managed by the Fresh Start PCMH may represent more access to care coordination, behavioral health services, and trauma-informed care, with more pronounced effects on primary care and pharmacy costs.

A New Method to Extract Health-Related Quality of Life Data From Social Media Testimonies: Algorithm Development and Validation

BackgroundMonitoring social media has been shown to be a useful means to capture patients’ opinions and feelings about medical issues, ranging from diseases to treatments. Health-related quality of life (HRQoL) is a useful indicator of overall patients’ health, which can be captured online.ObjectiveThis study aimed to describe a social media listening algorithm able to detect the impact of diseases or treatments on specific dimensions of HRQoL based on posts written by patients in social media and forums.MethodsUsing a web crawler, 19 forums in France were harvested, and messages related to patients’ experience with disease or treatment were specifically collected. The SF-36 (Short Form Health Survey) and EQ-5D (Euro Quality of Life 5 Dimensions) HRQoL surveys were mixed and adapted for a tailored social media listening system. This was carried out to better capture the variety of expression on social media, resulting in 5 dimensions of the HRQoL, which are physical, psychological, activity-based, social, and financial. Models were trained using cross-validation and hyperparameter optimization. Oversampling was used to increase the infrequent dimension: after annotation, SMOTE (synthetic minority oversampling technique) was used to balance the proportions of the dimensions among messages.ResultsThe training set was composed of 1399 messages, randomly taken from a batch of 20,000 health-related messages coming from forums. The algorithm was able to detect a general impact on HRQoL (sensitivity of 0.83 and specificity of 0.74), a physical impact (0.67 and 0.76), a psychic impact (0.82 and 0.60), an activity-related impact (0.73 and 0.78), a relational impact (0.73 and 0.70), and a financial impact (0.79 and 0.74).ConclusionsThe development of an innovative method to extract health data from social media as real time assessment of patients’ HRQoL is useful to a patient-centered medical care. As a source of real-world data, social media provide a complementary point of view to understand patients’ concerns and unmet needs, as well as shedding light on how diseases and treatments can be a burden in their daily lives.