Quality Patient-centered Care Research Articles

Assessment of potential drug-drug interactions in hospitalized patients with infectious diseases: an experience from a secondary care hospital

Background Polypharmacy is common among hospitalized patients with infectious infections owing to comorbidities or concomitant illnesses. This raises the likelihood of drug-drug interactions and creates uncertainty for healthcare providers. This study aimed to assess the potential drug-drug interactions (pDDIs) among hospitalized patients with infectious diseases in a secondary care hospital. Methods A prospective observational study was conducted in the internal medicine ward for six months after the ethics committee’s approval. Data were collected from patient case records, and prescriptions were screened for pDDIs from a portable electronic physician information database (PEPID) resource analyzed using SPSS, version 27.0. Results In total, 148 patient case records were analyzed, and 549 pDDIs were identified, with 66.8% having at least one or more DDIs. The mean number of drug interactions was 3.70 ± 4.58 per prescription. The most frequently encountered drug interactions were drug combinations such as bisoprolol with atorvastatin and aspirin with tazobactam/piperacillin. Bivariate analysis showed that age, comorbidities, length of hospital stay, and the number of drugs prescribed were risk factors associated with DDIs (p<0.05). In the multiple binary logistic regression analysis, DDIs were significantly associated with comorbidities and the number of prescribed medications (p<0.0001). Conclusions This study observed the prevalence of DDIs in hospitalized patients with infectious diseases of ‘moderate’ severity. Prescription screening using a drug information database assists in early identification and prevention of DDIs, enhancing drug safety and quality of patient-centered care.

Leadership in nursing: the key to quality care and professional development (literature review)

Leadership in nursing is an important component of effective work of medical organizations, it not only contributes to improving the quality of medical care, but also actively influences the atmosphere in the team and motivation of employees. Patient-centered quality care, the need for teamwork and change management place high demands on nurses as leaders.

Socioeconomic and demographic patterning of family uptake of a paediatric electronic patient portal innovation.

Patient portals allowing access to electronic health care records and services can inform and empower but may widen existing sociodemographic inequities. We aimed to describe associations between activation of a paediatric patient portal and patient race/ethnicity, socioeconomic status and markers of previous engagement with health care. A retrospective single site cross-sectional study was undertaken to examine patient portal adoption amongst families of children receiving care for chronic or complex disorders within the United Kingdom. Descriptive and multivariable regression analysis was undertaken to describe associations between predictors (Race/Ethnicity, age, socio-economic deprivation status based on family residence, and previous non-attendance to outpatient consultations) and outcome. A sample of 3687 children, representative of the diverse 'real world' patient population, was identified. Of these 37% (1364) were from a White British background, 71% (2631) had English as the primary family spoken language (PSL), 14% (532) lived in areas of high deprivation, and 17% (643) had high (>33%) rates of non-attendance. The families of 73% (2682) had activated the portal. In adjusted analyses, English as a PSL (adjusted odds ratio [aOR] 1.58, 95% confidence interval 1.29-1.95) and multi-morbidity (aOR 1.26, 1.22-1.30) was positively associated with portal activation, whilst families from British Black African backgrounds (aOR 0.68, 0.50-0.93), and those with high rates of non-attendance (aOR 0.48, 0.40-0.58) were less likely to use the portal. Family race/ethnicity and previous low engagement with health care services are potentially key drivers of widening inequity in access to health care following the implementation of patient portals, a digital health innovation intended to inform and empower. Health care providers should be aware that innovative human-driven engagement approaches, targeted towards previously underserved communities, are needed to ensure equitable access to high quality patient-centred care.

Improving access and quality of primary healthcare through women and adolescents' user committees: A mixed-methods case study in Kinshasa, Democratic Republic of the Congo.

Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare. Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower levels of engagement, in participation in health research or in health system improvement. With the aim of giving a voice to under-represented community groups in healthcare governance, the Access to Health services in Kinshasa (ASSK) project supported the implementation of primary health services user committees in the Democratic Republic of the Congo, designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents. Using a mixed-method case study design combining quantitative secondary data (from the national health management information system-DHIS2) and qualitative data from two research World Café (WC1: Women user committees (WUC) n=55; WC2: Adolescents user committee (AUC) n=63), this paper looks at the implementation facilitators and barriers, and at the results of this initiative. Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their 'soft skills' such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centres (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of SRH services (increase of 613% for Makala and 160% for Maluku II), including adolescent family planning (increase of 320% for Makala and 12% for Maluku II) and assisted childbirth for women15-49years old (increase of 283% for Makala and 23% for Maluku II)). Patient user committees for specific marginalised or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximise its potential.

Oncology nurses’ assessment of providing equitable care for patients with developmental disabilities.

164 Background: Access to quality health care can be challenging, especially for people with developmental disabilities (PwDD). Developmental Disabilities (DD) occur before age 22 and include physical, learning, language, or behavioral impairments. Studies of training and experience of oncology nurses (RNs) who care for PwDD are limited. The purpose of this study was to explore to what extent RNs working in a community oncology practice are prepared to provide quality patient-centered care to patients with DD. Methods: As no tool exists to capture oncology RNs experiences caring for PwDD, a survey was developed with input from a group of oncology nurse experts. Both academic IRB and Privacy Board approvals were completed prior to recruitment. A Qualtrics survey link was shared with RNs and Advanced Practice RNs via email. Questions about nurses’ background, perceptions of clinic resources and accommodation and referral to clinical trials were included in the survey. Nurses were also presented with 3 scenarios of oncology patients who have either been blind since birth, have autism or cerebral palsy. RN respondents were asked how to care for them, what challenges might be encountered, and what resources would be available to them. Results: Usable surveys were completed by 122 RNs. 77 RNs cared for PwDD in a statewide Oncology practice, 81 RNs had previously cared for PwDD in any setting and 54 RNs have friends or family members with DD. Only 7 RNs reported no experience with PwDD. Seven nurses knew of PwDD who had participated in clinical trials. Themes identified through the qualitative analysis include Accommodations, Strategies, Communication and Referrals. Conclusions: This study provides an initial step in understanding how to reduce disparities for oncology patients with DD. Key elements revealed additional training needs, standardized facility accommodation needs, and advocacy for clinical trials participation. Through a team approach and engagement with patient advocacy groups, the challenge of engaging PwDD in clinical trials will be tackled. More training and resource education for RNs and staff regarding care of PwDD will be built and disseminated through a standardized process to bridge gaps to impact delivery of care.

2283 Early supported discharge for fragility fractures -collaborative working to deliver responsive high quality patient-centred care

Abstract Introduction During 2022, non-femoral fractures that didn’t require operative management had 30 days median inpatient length of stay (LOS) at SBUHB. Femoral fracture patients >65 years had LOS 36 days (GIRFT average 19 days), with 720 admissions. High local incidence is believed to be contributed by historical failures to identify and treat non-femoral fragility fractures. A new service was created from a collective effort to do better for our patients and prevent avoidable harm by breaking down barriers between services and promoting effective collaborative working. Methods A collaboration between the following key services was formed:-. 1. Older Persons Assessment Service (OPAS) -identify fragility fractures presenting to ED 2. Orthogeriatrics -identify suitable femoral fracture patients. 3. Physiotherapy -early assessment and transfer to reablement into the community. 4. Virtual Wards –ongoing CGA and reablement in the community. Additional resource was secured to provide short-term bridging of care and community therapy input. Data was prospectively collected and included demographics, site of fracture, referrer and LOS. Results From March 2023, the service identified 457 patients, 312 (68.7%) Female, median age 86 years. 157 (34.6%) patients had a femoral fracture and 300 (65.4%) were non-femoral fragility fractures, majority identified by OPAS, with 206 (68.7%) being discharged same day. Overall, admission was avoided in 207 (45.3%) patients and 247 (54.6%) had an early discharge/reduced LOS with 3(0.1%) re-admissions avoided. The mean LOS on discharge is 6.6 days with a calculated monthly bed saving of 13.9 days across the service. Conclusion Collaborative working has created an early supported discharge pathway. Femoral fracture patients are discharged earlier, some 3 days post-op, with the necessary support to continue reablement at home. Fragility fractures are identified at the front door and offered same-day discharge with ongoing comprehensive geriatric assessment and reablement within the virtual wards with positive feedback from patients and their families.

Assessment of potential drug-drug interactions in hospitalized patients with infectious diseases: an experience from a secondary care hospital

Background Polypharmacy is common among hospitalized patients with infectious infections owing to comorbidities or concomitant illnesses. This raises the likelihood of drug-drug interactions and creates uncertainty for healthcare providers. This study aimed to assess the potential drug-drug interactions (pDDIs) among hospitalized patients with infectious diseases in a secondary care hospital. Methods A prospective observational study was conducted in the internal medicine ward for six months after the ethics committee’s approval. Data were collected from patient case records, and prescriptions were screened for pDDIs from a portable electronic physician information database (PEPID) resource analyzed using SPSS, version 27.0. Results In total, 148 patient case records were analyzed, and 549 pDDIs were identified, with 66.8% having at least one or more DDIs. The mean number of drug interactions was 3.70 ± 4.58 per prescription. The most frequently encountered drug interactions were drug combinations such as bisoprolol with atorvastatin and aspirin with tazobactam/piperacillin. Bivariate analysis showed that age, comorbidities, length of hospital stay, and the number of drugs prescribed were risk factors associated with DDIs (p<0.05). In the multiple binary logistic regression analysis, DDIs were significantly associated with comorbidities and the number of prescribed medications (p<0.0001). Conclusions This study observed the prevalence of DDIs in hospitalized patients with infectious diseases of ‘moderate’ severity. Prescription screening using a drug information database assists in early identification and prevention of DDIs, enhancing drug safety and quality of patient-centered care.

How team-based are rural or underserved clinics where AHEC scholars train?

BackgroundInterprofessional collaborative practice is an important feature of delivering high quality patient-centered care. Understanding what students learn during their clinical rotations about how healthcare teams function, particularly in rural and underserved settings is important for addressing health disparities in these populations. PurposeTo determine the extent to which healthcare teams located in rural or underserved clinics that host AHEC Scholars engage in teamwork and team-based care. MethodsThe 15-item Assessment for Collaborative Environments (ACE-15) instrument, measuring interprofessional teamwork and team cohesion was administered to team members at 17 rural or underserved clinics and demographic information was collected. ResultsSeveral significant differences in mean ACE-15 scores were found among team types, clinic types and settings: community-based clinics scored higher compared to their university-based counterparts and clinics in rural settings scored higher compared to those in urban settings. Primary care-based teams scored higher compared to non-primary care-based teams. ConclusionsTraining students within healthcare teams across multiple settings and locations is paramount to their preparation for interprofessional work.

Trust in health workers and patient-centeredness of care were strongest factors associated with vaccination for Kenyan children born between 2017–2022

ObjectiveAlthough vaccination confidence is declining globally, there is little detailed information from low- and middle-income countries about factors influencing routine vaccination behavior in these contexts. MethodsIn mid-2022, we surveyed people who gave birth in Kenya between 2017–2022, and asked them about their children’s vaccination history and about hypothesized correlates of vaccination per the Behavioural and Social Drivers of Vaccination model. ResultsOf 873 children in this sample, 117 (13%) were under-vaccinated (i.e., delayed or missing vaccine dose(s)) – and under-vaccination was more common among births during the COVID-19 pandemic (2020–2022) versus pre-pandemic (2017–2019). In multi-level multivariable models, children of respondents who expressed concerns about serious side effects from vaccines had significantly higher odds of missed vaccine dose(s) (aOR 2.06, 95 % CI 1.14–3.72), and there was a strong association between having more safety concerns now versus before the COVID-19 pandemic (aOR missed dose(s) 4.44, 95 % CI 1.71–11.51; aOR under-vaccination 3.03, 95 % CI 1.28–7.19). People with greater trust in health workers had lower odds of having a child with missed vaccine dose(s) (aOR 0.85, 95 % CI 0.75–0.97). People who reported higher patient-centered quality of vaccination care had much lower odds of having children with delayed or missed vaccine dose(s) (aOR missed dose(s) 0.14, 95 % CI 0.04–0.58; aOR under-vaccination 0.27, 95 % CI 0.10–0.79). ConclusionsThese findings highlight potential strategies to improve vaccine coverage: greater focus on patient-centered quality of care, training healthcare workers on how to address safety concerns about vaccines, and building trust in the health care system and in health workers.

Patient perceptions of advanced practice radiation therapists prescribing medication in radiation therapy

IntroductionThe purpose of this study was to determine patient perceptions of an advanced practice radiation therapist (APRT) prescribing medication for radiation therapy treatment-related side effects. By comprehending patient perceptions, it is important to implement change in order to improve patients’ quality of life. MethodsA literature review was conducted on advanced practice (AP) roles in Canada and world-wide; the roles searched were: APRT, nurse practitioner and pharmacist. The search focused on evidence demonstrating improvements made to patient care due to the implementation of these roles. Based on this review and input from a team of experts a qualitative semi-structured interview survey was designed, and pilot tested. The survey consisted of five open-ended questions, which were designed to determine patient satisfaction of an APRT prescribing medication over the course of their radiation therapy treatments. Patients undergoing head and neck radiation therapy treatments at a large, academic cancer centre were invited to participate. Six patients who had a head and neck APRT involved in their treatment were interviewed. A comprehensive thematic analysis was then conducted using the transcripts created from these interviews, which was followed by two independent blinded analyses to ensure validity of the results. DiscussionThe thematic analysis produced four salient themes which were: side effect management, care provided by the APRT in comparison to other healthcare workers, patients’ access to care, and overall patient satisfaction. Common medications for head and neck radiation therapy treatment related side effects were discussed and these were: Magic Mouthwash, Xylocaine, Nystatin, Benadryl, Advil, Tylenol, Dexamethasone, Tantum, Biotene, Mucaine, Flamazine, Hydrocortisone, Ondansetron, Senokot, and narcotics. ConclusionThis study was valuable to understand patient experiences and provide evidence to change processes in order to improve quality of patient centered care. The study revealed that although patients were happy with the process of prescribing medication, they all agreed that having an advanced practice radiation therapist prescribe would improve care. Patient responses further demonstrated the need for future research in regards to side effect management as a whole by APRTs as well as how role clarification can impact patient perceptions of APRTs.

The association between a patient-centered quality of care index and self-efficacy among cancer survivors.

The number of cancer survivors in the US surpassed 18.1 million in 2022 and this number continues to grow. Patient self-efficacy, a patient's confidence in his or her ability to self-manage symptoms and healthcare concerns, has been linked to improved health outcomes. We thus set out to examine the association between a patient-centered care quality index and self-efficacy among cancer survivors. Data from 777 survivors of breast, prostate, and colorectal cancers at 32 cancer centers nationwide were collected 6months after an initial survivorship visit. Patients completed surveys assessing patient-centered care (36 items under seven factors) and individual self-efficacy (eight items). Multiple linear regression was used to examine the association between patient-centered care and patient self-efficacy, adjusting for demographics, cancer-related characteristics, and organizational characteristics of high-quality patient-centered survivorship care. In descriptive analyses, there were no statistically significant differences in demographic or cancer-related characteristics between cancer survivors by quality of patient-centered care. In regression models, a one-unit increase in patient-centered care was associated with a 0.23 (95% CI 0.14-0.32) increase in mean self-efficacy compared to low quality of patient-centered care when adjusting for demographics, cancer-related characteristics, and indicators of high-quality survivorship care. Individually, four of the seven factors of quality patient-centered care were statistically significantly associated with greater self-efficacy. Having a medical home was associated with the greatest increase in self-efficacy among survivors. Our findings indicate that higher quality patient-centered care is associated with greater cancer survivor self-efficacy. Given that self-efficacy is correlated with improved health outcomes and quality of life, this finding further supports the importance of high-quality patient-centered survivorship care. High-quality patient-centered survivorship care was associated with higher patient self-efficacy. This association should further be explored among cancer survivors with diverse characteristics.

Assessment of potential drug-drug interactions in hospitalized patients with infectious diseases: an experience from a secondary care hospital

Background Polypharmacy is common among hospitalized patients with infectious infections owing to comorbidities or concomitant illnesses. This raises the likelihood of drug-drug interactions and creates uncertainty for healthcare providers. This study aimed to assess the potential drug-drug interactions (pDDIs) among hospitalized patients with infectious diseases in a secondary care hospital. Methods A prospective observational study was conducted in the internal medicine ward for six months after the ethics committee’s approval. Data were collected from patient case records, and prescriptions were screened for pDDIs from a portable electronic physician information database (PEPID) resource analyzed using SPSS, version 27.0. Results In total, 148 patient case records were analyzed, and 549 pDDIs were identified, with 66.8% having at least one or more DDIs. The mean number of drug interactions was 3.70 ± 4.58 per prescription. The most frequently encountered drug interactions were drug combinations such as bisoprolol with atorvastatin and aspirin with tazobactam/piperacillin. Bivariate analysis showed that age, comorbidities, length of hospital stay, and the number of drugs prescribed were risk factors associated with DDIs (p<0.05). In the multiple binary logistic regression analysis, DDIs were significantly associated with comorbidities and the number of prescribed medications (p<0.0001). Conclusions This study observed the prevalence of DDIs in hospitalized patients with infectious diseases of ‘moderate’ severity. Prescription screening using a drug information database assists in early identification and prevention of DDIs, enhancing drug safety and quality of patient-centered care.

Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening

ObjectivesLung cancer screening is a complex and individualized decision. To understand how best to support patients in this decision, we must understand how shared decision-making is associated with both decisional and behavioral outcomes. MethodsObservational cohort study combining patient survey data with electronic health record data of lung screening-eligible patients who recently engaged in a shared decision-making discussion about screening with a primary care clinician. ResultsUsing multivariable analysis (n = 529), factors associated with higher lung cancer screening decisional quality include higher knowledge (OR = 1.33, p < .0001), lower perceived benefits (OR = 0.90, p = .0004), higher perceived barriers (OR = 1.07, p < .0001), higher self-efficacy (OR = 1.13, p < .0001), and higher levels of perceiving the discussion was shared (OR = 1.04, p < .0001). Factors associated with the patient’s decision to screen include older age (OR = 1.12, p = .0050) and higher self-efficacy (OR = 1.11, p = .0407). Factors associated with screening completion included older age (OR = 1.05, p = .0050), higher knowledge (OR = 1.24, p = .0045), and higher self-efficacy (OR = 1.12, p = .0003). ConclusionsShared decision-making in lung cancer screening is a dyadic process between patient and clinician. As we continue to strive for high-quality patient-centered care, patient decision quality may be enhanced by targeting key factors such as high-quality knowledge, self-efficacy, and fostering a shared discussion to support patient engagement in lung cancer screening decisions.

An Orthopaedic perspective on developing a Patient Experience Survey tool

Introduction: Our program’s aim is to integrate patients' values and perceptions of quality care into clinical decision-making and integrated orthopaedic care models that are reflective of the community/population that is served. Our institution currently has limited patient experience data or standardized tools that would allow us to comprehensively understand patient perspective across our orthopaedic populations. To that end, we designed a survey to understand patients’ experiences and any gaps that would require actionable change in real-time.&#x0D; Objectives and Methodology: The goal was to develop a survey tool that can meaningfully capture patient needs and preferences that impact their experiences and help identify any gaps or areas of opportunity to address. An environmental scan was completed which identified two validated patient experience surveys used to inform our survey development: CIHI’s CPES-IC (Canadian Institue for Health Information Canadian Patient Experience Survey - Inpatient Care) and OHA (Ontario Hospital Association) Outpatient Experience Survey. The survey was tested across a multidisciplinary team via feedback surveys and focus groups: 6 Patient Partners, 1 Clinical Manager, 3 Advanced Practice Practitioners, 3 Orthopaedic Surgeons, 4 Researchers, and 2 Administrators. Findings were collated and used to iterate the survey content until consensus was reached on a final patient experience survey. &#x0D; Highlights or Results or Key Findings: The focus of the survey is on understanding the patient’s Outpatient experience with their care team in orthopaedic clinics from referral to assessment. The survey was designed to cover multiple orthopaedic populations including patients with Hip and Knee, Foot and Ankle, Shoulder, Elbow and Spine issues. It focuses on two key components of the patient journey: 1) Pre-appointment and 2) Post-appointment. The pre-appointment pathway was deemed to be important as patient experience is often captured once care is delivered and it was important to understand how patients perceive their pre-appointment experience defined as the time from referral through day of appointment up to the time patients are seen (arrival at hospital, checking in to clinic). Specifically, the pre-appointment survey has up to 42 questions that aim to capture the patients’ perspectives on the clinic’s communication practices, wait time to be contacted, wait time for an appointment, how prepared patients felt for their appointment, how they felt about access to the clinic, their experiences with care transitions, their thoughts on transportation and any education that they received, and their overall experience. The post-appointment survey has up to 41 questions focused on understanding the patients’ perspectives on care transitions, the clinic space; wait time to see the practitioner, expectations, engagement in decision making, communication practices, education they received, and any other factors impacting their experience (e.g. confidentiality, empathy, trust, dignity). &#x0D; Conclusion and Next Steps: The survey, reviewed with our patient partners and multidisciplinary team, was found to be comprehensive and have good face validity. The survey will be implemented and the data will be analyzed to understand themes around areas of success and areas of improvement to advance our integrated models of care in order to provide high quality patient-centered care.

Patients' perceived quality of the care provided during the management of HIV/AIDS in a tertiary care setting in Nigeria.

The provision of patient-centred care by clinicians is believed to improve patient satisfaction with care as well as the outcome of treatment. To assess the quality of personalized care provided to people living with HIV/AIDS in a typical Nigerian health care setting and its association with patients' knowledge and attitude towards HIV/AIDS and patients' knowledge and attitude towards antiretroviral therapy. The study was a cross sectional study carried out in the HIV/AIDS clinic of the University of Uyo Teaching Hospital, Nigeria. Data on the demographic and clinical details of the patients were obtained from patients' case notes using a suitably designed, pre-piloted data collection instrument. Furthermore, data on the quality of patient-centred care, patients' knowledge and attitude towards HIV/AIDS, and patients' knowledge and attitude towards antiretroviral therapy was obtained using 'Patient Assessment of Quality of Individualized care for Chronic Illness Scale', 'Patient knowledge and attitude towards HIV/AIDS questionnaire; and 'Patient knowledge and attitude towards antiretroviral therapy questionnaire', respectively.Quantitative data were analysed using Statistical Program and Service Solutions (SPSS) version 25.0 computer package. Descriptive statistics were used to summarize data, while inferential statistics were used where applicable with statistical significance set at p<0.05. The overall mean patients' satisfaction with individualized care score was 3.54 (SD = ±0.86; Max. = 5). The mean scores of the patients' knowledge and attitude towards HIV/AIDS were 6.80 (SD = ± 1.079; Max. = 8) and 5.5 (SD = ± 0.924; Max. = 7) respectively, while the mean scores of the patients' knowledge and attitude toward antiretroviral therapy were 5.7 (SD = ± 1.103; Max. = 10) and 4.2 (SD = ± 0.874; Max. = 6). Multivariate linear regression revealed that the quality of patient centred care was a predictor of knowledge and attitude towards antiretroviral therapy (B=0.511; CI = 95%, p = 0.024). The quality of patient-centred care provided to persons living with HIV/AIDS in the facility is satisfactory. Patients perceived quality of care appear to be a predictor of knowledge and attitude towards antiretroviral therapy.

Patient-Centered Quality Measures for Dialysis Care: A Report of a Kidney Disease Outcomes Quality Initiative (KDOQI) Scientific Workshop Sponsored by the National Kidney Foundation

Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.

Rural Hospital Disparities in Goals of Care Documentation.

Goals of care conversations for seriously ill hospitalized patients are associated with high-quality patient-centered care. We aimed to assess the prevalence of documented goals of care conversations for rural hospitalized patients compared to nonrural hospitalized patients. We retrospectively assessed goals of care documentation using a template note for adult patients with predicted 90-day mortality greater than 30% admitted to eight rural and nine nonrural community hospitals between July 2021 and April 2023. We compared predictors and prevalence of goals of care documentation among rural and nonrural hospitals. Of the 31,098 patients admitted during the study period, 21% were admitted to a rural hospital. Rural patients were more likely than nonrural patients to be >65 years old (89% vs. 86%, P=<.0001), more likely to live in a neighborhood classified in the highest quintile of socioeconomic disadvantage (40% vs. 16%, P=<.0001), and less likely to receive a palliative care consult (8% vs. 18%, P=<.0001). Goals of care documentation occurred less often for patients admitted to rural vs. nonrural community hospitals (2% vs. 7%, P < .0001). In the base multivariable logistic regression model adjusting for patient characteristics, the odds of goals care documentation were lower in rural vs. nonrural community hospitals (aOR 0.4, P=.0232). In a second multivariable logistic regression model including both patient characteristics and severity of illness, the odds of goals of care documentation in rural community hospitals were no longer statistically different than nonrural community hospitals (aOR 0.5, P=.1080). Patients who received a palliative care consult had a lower prevalence of goals of care documentation in rural vs. nonrural hospitals (16% vs. 37%, P=<.0001). In this study of 17 rural and nonrural community hospitals, we found low overall prevalence of goals of care documentation with particularly infrequent documentation occurring within rural hospitals. Future study is needed to assess barriers to goals of care documentation contributing to low prevalence of goals of care conversations in rural hospital settings.

Piloting patient-reported outcome measures for evaluation of the Irish Chronic Disease Programme

Abstract Background The Irish National Integrated Care Programme for Chronic Disease (ICPCD) aims to deliver end-to-end, patient-centred care across three clinical programmes; Heart, Respiratory and Diabetes. Patient-reported outcome measures (PROMs) are a means of objectively measuring changes in patients’ subjectively-perceived health status over time in response to services. As such, PROMs facilitate service monitoring and evaluation and are an important tool for the ICPCD to ensure optimal, patient-centred, value-based healthcare delivery. Methods To select the most appropriate PROMs instrument for use across ICPCD, comprehensive literature review was undertaken followed by key stakeholder consultation in winter 2022. Following consideration against a set of pre-determined criteria the EQ-5D-5L, a well-validated, reliable PROMs instrument, was selected as the most appropriate PROMs instrument for use. Study design involved pilot implementation of EQ-5D-5L in one ICPCD ambulatory care hub service followed by mixed methods evaluation of staff experience of the pilot. Results The pilot was conducted from April to June 2023 among a socio-demographically diverse sample of patients attending their first and last episode of care with the ICPCD diabetic patient education service in Galway. Following service attendance there was a significant aggregate improvement in self-reported overall health rating but no significant change in self-reported mobility, self-care, usual activities, pain/discomfort or anxiety/depression. Predominant staff concerns included staff and patient burden and the need for adequate staff resourcing and information technology support. Conclusions In conjunction with key national stakeholders findings from the pilot will be used to support the development of a PROMs implementation plan at scale for adoption across all ICPCD services. Ultimately national implementation will support the ongoing delivery of high quality patient-centred care within ICPCD services. Key messages • PROMs facilitate service evaluation and are an important tool for the Irish National Integrated Care Programme for Chronic Disease (ICPCD) to ensure optimal patient-centred healthcare delivery. • This pilot will support PROMs implementation at scale across ICPCD services and ultimately reinforce the ongoing delivery of high-quality, value-based, integrated healthcare.

Cardiovascular disease patient reported experiences with a web-based, interactive, clinically integrated cardiac rehabilitation program

Abstract Funding Acknowledgements Type of funding sources: None. Background/introduction Patient reported experience measures (PREMS) encompasses a person’s interactions within the healthcare system. Understanding the patient experience is key to quality patient-centered care, and evaluating these experiences is essential to improving clinical outcomes and health care quality. Cardiac rehabilitation (CR) programs contribute to redressing cardiovascular disease (CVD) morbidity and mortality by slowing the progression of CVD and restoring quality of life. There is consensus that CR suboptimal attendance and completion is multifactorial, and that different causes are involved. Thus, evaluating patient experience to improve CR program attendance and completion and reduce the burden of CVD is essential. Method A retrospective descriptive survey design was used for patients ≥18 years, who were enrolled and active with the interactive, and clinically integrated web-based program for their CR between July 2021 to December 2022. The primary outcome was patient experience, and the aim was to evaluate this experience. Results Of the 54 enrolled patients, 16 met the inclusion criteria and received an online survey link. Of these 9 (56.3%) responded. Most respondents were aged between 60-70 years (55.6%) and male (77.8%). Seven (77.8%) did a web-based program only, and hybrid (combined web-based and centre CR) were two, (22.2%). The main reasons for choosing this mode of delivery were restrictions relating to the COVID-19 pandemic (66.7 %), and/or geographical isolation and work commitments (33.3%). Most stated that they participated in their goal setting (89%), and 77.8% achieved these goals. Program completion was reported by 77.5% of patients, with 7.89 (SD 4.12) mean weeks completed. Information delivered in the education sessions was clear and easy to understand, contributing to positive lifestyle changes as reported by 77.7% of patients. All patients reported increased confidence across the CR health domains and being treated with respect and dignity. Regarding Phase 3 CR, extended ongoing outpatient attendance and exercise programs, 77.9% reported working with their GP and practice nurse to maintain lifestyle changes. Overall patients reported a positive experience from the web-based CR program stating, "I found this program to be very beneficial and would strongly recommend it to people having heart ops. Pity about covid stopping me attending face to face sessions. The phone and internet support was top notch". Conclusions Patients reported a high level of satisfaction with the education received and respect and dignity shown via a web-based CR program. This is fundamental to engagement with the program, behavior change and improved clinical outcomes in particular for patients with no access to center-based CR due to pandemics, work commitments and geographical isolation.

“The right thing to do would be to provide care… and we can’t”: Provider experiences with Georgia’s 22-week abortion ban

ObjectivesIn 2015, the Georgia (US) legislature implemented a gestational limit, or “ban” on abortion at or beyond 22 weeks from the last menstrual period. In this study, we qualitatively examined abortion provider perspectives on the ban’s impact on abortion care access and provision. Study designBetween May 2018 and September 2019, we conducted in-depth individual interviews with 20 abortion providers (clinicians, staff, and administrators) from four clinics in Georgia. Interviews explored perceptions of and experiences with the ban and its effects on abortion care. Team members coded transcripts to 100% agreement using an iterative, group consensus process, and conducted a thematic analysis. ResultsParticipants reported strict adherence to the ban and also its negative consequences: additional labor plus service-delivery restrictions, legally constructed risks for providers, intrusion into the provider-patient relationship, and impact of limited services felt by patients and, thus, providers. Participants commonly mentioned disparities in the ban’s impact and viewed the ban as disproportionately affecting people of color, those experiencing financial insecurity, and those with underlying medical conditions. Nonetheless, participants described a clear, unrelenting commitment to providing quality patient-centered care and dedication to and satisfaction in their work. ConclusionsGeorgia’s ban operates as legislative interference, adversely affecting the provision of quality, patient-centered abortion care, despite providers’ resilience and commitment. These experiences in Georgia have timely and clear implications for the entire country following the Supreme Court’s decision to overturn Roe v Wade, thus reducing care access and increasing negative health and social consequences and inequities for patients and communities on a national scale. ImplicationsOur findings from Georgia (US) indicate an urgent need for coordinated efforts to challenge the Dobbs v Jackson Women’s Health Organization decision and for proactive policies that protect access to later abortion care. Research that identifies strategies for supporting providers and patients faced with continuing restrictive legal environments is warranted.