Patient-centered Strategies Research Articles

A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency.

Opioids are commonly used following outpatient surgery. However, we understand little about patients' perspectives and how patients decide on postoperative opioid use. This study seeks to investigate aspects of patients' thought processes that most impact their decisions. The authors conducted semistructured interviews with 30 adults undergoing minor elective hand surgery at one tertiary hospital. Narratives were content-coded to arrive at the authors' thematic analysis. The authors incorporated Bandura's concept of self-agency to interpret the data and develop a conceptual framework that best explained the implicit theory within participants' responses. The authors found six themes under two domains of self-agency. Participants actively sought out protective mechanisms supporting their decision on opioid use, but sometimes did so unconsciously. They would avoid opioids postoperatively because they were "tough" and wanted to evade the risk of addiction as "good citizens." They conveyed a nuanced safety against addiction because they were "not the kind" to become addicted and because they trusted the surgeons' prescribing. However, participants felt discouraged by the stigma associated with opioids. Both intentionally and unintentionally, participants integrated a strong sense of self in their decision-making processes. A robust understanding of how patients choose to take opioids for postoperative pain control is imperative to develop patient-centered strategies to treat the opioid epidemic. Effective opioid-reduction policies should consider patients as active agents who negotiate various internal and external influences in their decision-making processes. Surgeons must incorporate patients' individual goals and perspectives regarding postoperative opioid use to minimize opioid-related harm after surgery.

Evaluation of an opioid restrictive pain management initiative in adult kidney transplant recipients.

Evidence to guide opioid utilization following kidney transplantation is lacking. The purpose of this study is to evaluate the implementation of an opioid restrictive post-operative pain management protocol in adult kidney transplant recipients. We analyzed patients who underwent kidney transplant between 1/1/2017 to 8/15/2018. A standardized, opioid restrictive pain management protocol was implemented in February 2018. The primary outcome was quantity of opioid tablets prescribed at discharge. Secondary outcomes included amount of opioid prescribed within first 30days, number of patient calls for pain, and opioid prescription in electronic medical record (EMR) at 90days and 1year. After implementation, significantly fewer opioid tablets were prescribed at discharge (4 vs. 60 tablets, p<.001) and less oral morphine milligram equivalence (OME) were prescribed within 30days of transplant (38 vs. 300, p<.001). In cohort 2, fewer patients received more than one opioid prescription, more patients received truncal block and only 5 patients received patient controlled analgesia compared to all in cohort 1. A standardized, patient-centered pain management strategy after kidney transplantation reduced opioid prescribing without increasing readmissions or clinic calls. This data may be used to inform guidelines for appropriate OME prescribing at discharge after kidney transplantation.

The future of precision medicine in opioid use disorder: inclusion of patient-important outcomes in clinical trials.

Objective:Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychosocial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials.Methods:In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT.Results:The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%).Conclusion:These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.

Quality of life and self-efficacy in patients with type 2 diabetes mellitus in a Peruvian public hospital.

Quality of life and self-efficacy assessments are increasingly applied in research with type 2 diabetes mellitus patients due to the impact of the disease on their lives. This study aimed to describe the quality of life and self-efficacy in type 2 diabetes mellitus patients and describe the association of quality of life and self-efficacy with demographic, metabolic, and clinical variables. This is a secondary data analysis from a cross-sectional study: Metabolic control in patients with type 2 diabetes mellitus in a public hospital in Peru: a cross-sectional study in a low-middle income country. Data were obtained by standardized interviews and evaluation of medical records. The evaluation tools used were the Diabetes 39 questionnaire (D-39) to measure the quality of life and the General Self-Efficacy scale (GSE) for self-efficacy. The median scores of the D-39 and GSE were 34.6 and 34, respectively. The D-39 dimension with the highest score was anxiety and concern. Better quality of life was associated with being older than 65 years old, not having complications, and the absence of depression. No significant association was found between self-efficacy and the quality of life score. Results suggest patients with type 2 diabetes mellitus have a poor quality of life. Patient-centered strategies for type 2 diabetes mellitus care must consider these psychosocial factors to improve disease control and quality of life.

The psychological burden of waiting for procedures and patient-centred strategies that could support the mental health of wait-listed patients and caregivers during the COVID-19 pandemic: A scoping review.

BackgroundWaiting for procedures delayed by COVID‐19 may cause anxiety and related adverse consequences.ObjectiveTo synthesize research on the mental health impact of waiting and patient‐centred mitigation strategies that could be applied in the COVID‐19 context.MethodsUsing a scoping review approach, we searched 9 databases for studies on waiting lists and mental health and reported study characteristics, impacts and intervention attributes and outcomes.ResultsWe included 51 studies that focussed on organ transplant (60.8%), surgery (21.6%) or cancer management (13.7%). Most patients and caregivers reported anxiety, depression and poor quality of life, which deteriorated with increasing wait time. The impact of waiting on mental health was greater among women and new immigrants, and those of younger age, lower socio‐economic status, or with less‐positive coping ability. Six studies evaluated educational strategies to develop coping skills: 2 reduced depression (2 did not), 1 reduced anxiety (2 did not) and 2 improved quality of life (2 did not). In contrast, patients desired acknowledgement of concerns, peer support, and periodic communication about wait‐list position, prioritization criteria and anticipated procedure date.ConclusionsFindings revealed patient‐centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID‐19 context.Patient or Public ContributionSix patients and four caregivers waiting for COVID‐19‐delayed procedures helped to establish eligibility criteria, plan data extraction and review a draft and final report.

Patient-Centered Treatment Strategies to Improve Outcomes in Schizophrenia.

Schizophrenia is a severe, lifelong disorder that affects cognitive, behavioral, and emotional functioning. Many individuals living with schizophrenia experience numerous relapses and ongoing impairment. To improve the clinical and functional outcomes for people with schizophrenia, clinicians should recognize the importance of adopting a patient-centered approach to treatment. Simplifying the medication regimen, using shared decision-making, and offering psychosocial interventions are strategies that may contribute to better outcomes.

Post-treatment head and neck cancer survivors' approaches to self-management: A qualitative study.

Post-treatment head and neck cancer (HNC) survivors contend with distinct, long-term challenges related to cancer treatments that impact their day-to-day lives. Alongside follow-up cancer care, they also must be responsible for the daily management of often intrusive physical and psychological symptoms, as well as maintaining their health and a lifestyle to promote their well-being. The purpose of this study was to identify HNC survivors' approaches toward engagement in self-management activities. Post-treatment HNC survivors (N=22) participated in the study through purposeful sampling. Participants were eligible if they 1) had a history of upper aerodigestive tract cancer; 2) completed their most recent primary treatment (i.e. chemotherapy, radiation, and surgery) more than eighteen months prior and had no evidence of HNC, and 3) could speak in English. A semi-structured interview was used. Data was analyzed using content analysis. We identified three approaches that survivors took towards self-management activities: taking charge, living with it, and engaging as needed. Our results showed that taking charge is when survivors take an active role in evaluating their health and taking action subsequently; as needed represents engaging in self-management as necessary; and living with it reflects adapting to the symptoms and side effects without managing them. We propose self-management approaches as a novel mechanism to understand the relationship between survivors' characteristics and health preferences and their self-management. It is important for clinicians to highlight the variation in individuals 'self-management approaches as they work to identify tailored patient-centered strategies that compliment specific patient needs.

Chemotherapy and Cancer Related Fatigue: A Prospective Study in Rural Cancer Survivors of Malwa Region of Punjab

The objective of this no interventional, 7 months observational study was to analyze the prevalence of cancer-related fatigue (CRF) in cancer patient populations who were receiving chemotherapy and those who were not receiving chemotherapy. This was an observational study. Based on the inclusion and exclusion criteria, 60 subjects (24 male and 36 females) diagnosed with cancer enrolled for the study, which was further allotted into group A (n=30) which was receiving chemotherapy and group B (n=30) which was not receiving chemotherapy. The data collection was performed by administering the validated Fatigue symptoms Inventory (FSI) scale after obtaining the informed consent. The mean age of Group A and B is 49 years and Group B 51 years, respectively. The mean FSI score of the group receiving chemotherapy was 35.70±17.14, whereas the mean FSI score of a group not receiving chemotherapy was 19.50±16.05. An Independent t-test was applied and the independent t value came out to be 2.18. An equal variance t-test reveals, statistically indicating a significant difference in FSI scores in groups receiving chemotherapy and not receiving chemotherapy (p=0.042). From the results, we concluded that Cancer-related fatigue is highly prevalent in patients who are receiving chemotherapy than those who are not receiving chemotherapy. The underlying causes of CRF are poorly understood and further research is warranted in order to assess CRF before and after treatment and develop effective, patient-centred management strategies and to improve quality of life.

Incentives and Support Programs to Improve Adherence to Tuberculosis Treatment

&#x0D; Three overviews of reviews and 11 systematic reviews were identified regarding the clinical effectiveness of adherence incentives in those who require assistance to complete their tuberculosis treatment.&#x0D; Four evidence-based guidelines were identified that provided recommendations regarding the use of adherence incentives in those who require assistance completing their tuberculosis treatment.&#x0D; The reported clinical effectiveness of adherence incentives for patients with tuberculosis was mixed. There were no detrimental effects of providing incentives, but there was also no conclusive evidence pointing to a clinical benefit. The overall quality of the included reviews was moderate to high.&#x0D; The included guidelines recommended that incentives and enablers be included as a part of a patient-centred strategy for treatment and for patients with active tuberculosis or patients at high risk; however, the evidence formulating these recommendations was of low certainty or quality. Two of the included guidelines were of high methodological quality, and 2 were of lower methodological quality.&#x0D;

Abstract OT-17-01: Solti-1903 hope: Real-world clinical practice study to assess the impact of using comprehensive genomic data on the next treatment decision making-choice in patients with locally advanced or metastatic breast cancer in Spain

Abstract BACKGROUND: Metastatic breast cancer (mBC) remains an incurable disease and is the cause of nearly all deaths from breast cancer. Targeted molecular therapies and the evolving role of next-generation sequencing (NGS) technologies are increasing and may improve outcomes in breast cancer patients. However, they are not being routinely used in the clinic. One strategy to overcome the barriers of implementing NGS in the clinic is to promote the active participation of mBC patients in the management of their disease. With this in mind, we designed HOPE (SOLTI-1903), a national real-world study where patients lead their inclusion, participation and follow-up in the study through a digital tool that will guide them in every step of the journey. Our objective is empowering mBC patients and gather real-world data about the utilization of molecular information in the management of mBC. TRIAL DESIGN: Patients diagnosed with mBC who are receiving, have just received, or will receive standard treatment or treatment in a clinical trial (CT) can be included. Demographic data, disease characteristics, treatment history and quality of life data will be collected through a digital tool (DT) by the patient. Patients are encouraged to involve their physician`s in the study journey. The study is complemented by a patient empowerment program including informative workshops and precision medicine video-tutorials. A total of 600 patients will be included in Spain. Patient Journey Once patients request to participate in HOPE through the DT, a dedicated team from SOLTI will assist them in the following steps while validating that eligibility criteria are met according to data introduced by themselves. Then, patients will receive instructions via DT to go to the nearest partner local laboratory, where they will sign the study consent form. A metastatic (preferably) or primary archival tumor sample will be requested to the patient’s reference hospital and analyzed by FoundationOne®CDx. Also, a blood sample will be collected and analyzed by Guardant360. For all patients, two NGS tests will be offered (If no tissue available, only blood test will be performed). Both molecular analyses results will be reviewed during regular meetings by a Molecular Advisory Board (MAB). The MAB, based on their joint experience in clinical oncology, genomics, molecular biology, bioethics and pathology, may add some advice to these reports via DT, making comments about detected molecular alterations and adding further recommendations for specific treatment options or available CT with targeted therapies. From that moment, patients will record their disease evolution in the DT each 3 months for 2 years. The primary objective is to assess the real-world clinical practice integrating molecular profiling in the Standard of Care management of mBC patients connected through a DT. Secondary objectives include to describe genetic mutational profile of mBC, to evaluate the enrollment rate in CT of patients engaged in a patient-centered strategy for molecular tumor assessment, to asses Progression Free Survival, Overall Survival and Quality of life status among patients enrolled in CT according to the tumor’s genomic profile and those receiving standard treatment and to describe logistic feasibility of the study. This study is sponsored by SOLTI and financially supported by Novartis and two non-profit organizations: Asociación Cáncer de Mama Metastásico y Fundación Actitud frente al Cáncer. Roche and Guardant Health provide their test for all patients. Citation Format: Ana Casas, Eva Ciruelos, Mafalda Oliveira, Cristina Saura, Meritxell Bellet, Sonia Pernas, Joaquín Gavilá, Montserrat Muñoz, María Vidal, Blanca Gonzalez Farré, Juan M. Cejalvo, Rafael Lopez, Ana Vivancos, Maurizio Scaltriti, Javier S. Bofill, Isabel Blancas, Emilio Alba, Valentina Boni, Susana De la Cruz, Elena Galve, Antonia Perelló, Mireia Margelí, Jordi Canes, Pamela Céliz, Helena Masanas, Rosa Olmos, Marga Fonts, Pilar Fernandez-Pascual, Patricia Villagrasa, Aleix Prat. Solti-1903 hope: Real-world clinical practice study to assess the impact of using comprehensive genomic data on the next treatment decision making-choice in patients with locally advanced or metastatic breast cancer in Spain [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-17-01.

Challenges in Measuring Applied Cognition: Measurement Properties and Equivalence of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) Applied Cognition Item Bank

ObjectiveTo present challenges in assessment of applied cognition and the results of differential item functioning (DIF) analyses used to inform the development of a computerized adaptive test (CAT). DesignMeasurement evaluation cohort study. DIF analyses of 107 items were conducted across educational, age, and sex groups. DIF hypotheses informed the evaluation of the results. SettingHospital-based rehabilitation from a single hospital system. ParticipantsA total of 2216 hospitalized patients (N=2216). InterventionsNot applicable. Main Outcome MeasuresApplied cognition item pool from multiple sources. ResultsMany items were hypothesized to show DIF, particularly for age. Information was moderately high in the lower (cognitive disability) tail of the distribution, but some items were not informative. Reliability estimates were high (>0.89) across all studied groups, regardless of estimation method. There were 35 items with DIF of high magnitude and 19 with accompanying supportive hypotheses. ConclusionsA key clinical tool in inpatient rehabilitation medicine is assessment of applied functional cognitive ability to inform patient-centered rehabilitation strategies to improve function. This was the first study to evaluate measurement equivalence of the applied cognition item pool across large samples of hospitalized patients. Although about one-third of the item pool evidenced DIF or low discrimination, results supported placement of most items into the bank and its use across groups differing in education, age, and sex. Six items were classified with salient DIF, defined as consistent DIF of high magnitude and or impact, with confirmatory directional DIF hypotheses, generated by content experts. These were recommended for adjustment or removal from the bank; 4 were deleted from the bank and 2 had lowered CAT exposure (administration frequency) rates. Many items hypothesized to show DIF contained content measuring constructs other than applied cognition such as physical frailty, perceptual difficulties, or skills reflective of greater educational attainment. Challenges in measurement of this construct are discussed.

Pleural Drainage Strategy After IPC Placement: A Focused Clinical Review.

The first indwelling pleural catheter (IPC) received Federal Drug Administration approval in 1997, nearly 40 years after John Chambers first described instillation of talc into the pleural space for palliation of malignant pleural effusions. Since then IPCs have revolutionized the management of malignant pleural effusions, providing an effective means of controlling dyspnea in the end stages of life without the pain and prolonged hospital stays long associated with chemical sclerosing agents. While palliation of symptoms is the primary purpose of IPCs, development of pleurodesis in the outpatient setting is often an important secondary goal. Historically, decisions regarding IPC drainage frequency have been largely arbitrary and only recently has the evidence started to emerge regarding the effects of specific drainage strategies on both symptom control and pleurodesis development. This focused clinical review explores the current literature regarding IPC drainage strategies as well as novel methods designed to improve the efficacy of IPCs in a thorough and systematic manner. In addition, this review provides an in-depth analysis and synthesis of the data focusing on key considerations needed to develop patient-centered and cost-effective strategies for the use of IPCs in malignancy.

Perceived work environment and patient-centered behavior: A study of selected district hospitals in the central region of Ghana.

IntroductionQuality work environment has been established as a marker of employee value creation. A plethora of qualitative evidence suggested that sustained focus on employee satisfaction through changes in the work environment, communication of patient-centered care strategic vision, management of staff workload, and workplace social support are factors that stimulate Patient-centered care. Yet, it seems that the effect of work environment on the patient-centered behavior of hospital employees has not been statistically estimated, and it is unclear which of the elements of the work environment best predict patient-centered behavior.MethodsUsing a survey design and quantitative methods to gather and analyze data, a sample of 179 respondents from three district hospitals were included in the study using a multi-stage proportional sampling technique. Data were collected using self-administered Likert item questionnaires. Simple linear regression was used to estimate the influence of work environment elements on patient-centered behavior. Stepwise multiple regression was used to determine the best predictors of patient-centered behavior of hospital employees.ResultsPerceived internal communication of patient-centered care strategies (β = 0.23; P<0.001), supervisor support (β = 0.31; P<0.001), coworker support (β = 0.50; P<0.001), and working conditions (β = 0.18; P<0.013) had a positive significant effect on patient-centered behavior of employees. Good predictors of employees’ patient-centered behavior were perceived coworker support (β = 0.51; P<0.001) and job characteristics (β = 0.16; P<0.01).ConclusionThe work environment of hospital employees significantly affects their patient-centered behavior. Co-worker support and job characteristics were the best predictors of the patient-centered behavior of hospital employees. Hospitals Managers seeking to improve patient-centered behavior through employee value creation may consider improved job characteristics in combination with workplace social support and or communication of PCC strategies and goals.

Web-based discussion forums reveal the person-centered relevance and importance of tinnitus.

An increasing number of health researchers are recognizing the benefits of crowdsourcing. Web-based discussion forums are well suited for collecting qualitative research data with tinnitus participants and forum posts can be evaluated using thematic analysis. The present study reports an innovative use of such qualitative data contributed by a group of 148 people with tinnitus and tinnitus professionals through the crowdsourcing platform Tinnitus Talk. While the primary research question was focused on defining symptom concepts, discussions were broad-ranging and extended far beyond this topic. Thematic analysis of the discussion conducted by two analysts identified three novel emerging themes and these were not pre-planned according to the moderator's script. These were (i) the lived experience of tinnitus, (ii) perspectives on interventions for tinnitus, and (iii) the experience of participating in a web discussion forum. These unexpected themes contribute to a richer and more in-depth understanding of tinnitus seen through the eyes of those who experience it on a daily basis. Findings are important since spontaneous themes presumably reflect issues that are of personal relevance and importance to the participants. They therefore give insights into future research directions and have implications for patient-centered counseling strategies that could be effective in clinic.

Using Authentic Chinese Doctor-Patient Consultations to Develop Patient-Centered Communication Skills

Researchers in Languages for Specific Purposes (LSP) have suggested the importance and benefits of using authentic spoken workplace discourses as teaching materials to develop students’ communication skills in professional settings. However, LSP course designers are still facing the challenges of selecting and collecting authentic workplace conversations, as well as designing instruction to teach the occupational spoken discourses effectively. To address these challenges, this paper presents an innovative module for Chinese for Medical Purposes for pre-med college students at the intermediate-high level. The module uses authentic doctor-patient consultations and adopts the Patient-Centered Clinical Method (PCCM) of Stewart et al. (2014), a clinically validated model in healthcare communication research. The current module demonstrates the approach to determine the student learning objectives based on the PCCM model and the instruction design aiming at guiding students to notice and analyze the discourse features and communication strategies employed by physicians to achieve patient-centered care. The paper also examines learners’ pre- and post-instruction roleplay performances. The qualitative findings show that the learners improved in using patient-centered communication strategies after instruction.

Exciting breakthroughs in the management of diabetes mellitus

Remarkable advances were observed in recent years in the management of patients with type 2 (T2DM) or type 1 (T1DM) diabetes mellitus. Regarding T2DM, changes in treatment paradigms were observed, moving from a glucocentric approach to a multi-risk strategy and, finally, in people at high risk, to a specific cardiorenal protection using new antidiabetic agents. Regarding T1DM, progresses combined new insulin analogues with better pharmacokinetics, continuous and flash glucose monitoring and improved insulin delivery systems with smart insulin pens and insulin pumps connected to glucose monitoring device, allowing better glucose control with less hypoglycaemia. Because of an increasing variety of therapeutic approaches, an individualized patient-centred strategy is recommended, ideally with the collaboration of a multidisciplinary team. Shared care, connected care and tele-medicine will play an increasing role in the management of T1DM, and most probably also T2DM, in a near future.

Digital Pills: Impact of Rising Technology

Digital Pills (DP) are an innovative drug-device technology that permits to combine traditional medications with a monitoring system to record data about medication adherence as well as patients’ physiological data without human intervention. The Digital Medicine System (DMS), a drug–device combination developed for patients with serious mental illness, together combines adherence measurement with pharmacologic action by placing an ingestible sensor in a pill, allowing for information sharing among patients, Health Care Providers (HCPs), and caregivers via a mobile interface. Non-adherence to medication compromises the helpfulness of psychiatric treatments in patients with Serious Mental Illness (SMI). The combination of wearable technology with a “Digital Ingestion Tracking Program” (DITP) embedded within a pain pill may allow patients, caregivers as well as healthcare providers to track ingestion of pills through the web or a Smartphone app. Digital adherence technology could be promising patient-centered strategies for monitoring adherence. In November 2017, the Food and Drug Administration (FDA) approved a version of a second-generation antipsychotic, aripiprazole; embedded with a sensor (Abilify MyCite). The paper highlights the impact of DMS and provides detailed review about it.

Update on the management of elderly patients with glioblastoma: a narrative review.

Glioblastoma in the elderly (>65 years of age) is associated with shorter overall survival (OS) than in younger patients. Best practice recommendations for elderly patients, especially those with borderline or poor performance status, remain a subject of debate amongst clinicians despite recent randomized trials. This review provides an updated evidence-based summary to inform the modern management of elderly patients with glioblastoma. Based on evidence from the CE.6 randomized controlled trial, hypofractionated radiation therapy administered over a three-week course (40 Gy in 15 fractions) concomitantly with temozolomide (TMZ) followed by adjuvant TMZ has been found to be superior to radiation therapy alone with mean OS of 9.3 vs. 7.6 months and progression-free survival (PFS) of 5.3 vs. 3.9 months. This regimen should be offered to newly-diagnosed elderly patients with glioblastoma with preserved functional status, and was not associated with a negative impact on health-related quality of life (QOL). Management of elderly patients with glioblastoma can be challenging and requires a patient-centered strategy. Personalized decisions accounting for clinical, psychosocial, molecular and treatment factors are critical for realistic decision making. The importance of discussing goals-of-care with patients and their caregivers early in the disease trajectory, and establishing capacity for decision-making and advanced care planning, is also reviewed.

Promoting a Therapeutic Healing Environment: A Retrospective Examination of HCAHPS "Quiet at Night" Across a Large New York Health System.

Promoting respite and sleep impacts a patient's health and their inpatient experience. As New York State's largest health system, Northwell Health has been on a journey to create a healing and therapeutic healthcare environment. By establishing leadership accountability, leveraging patient feedback and adopting evidence-based interventions, system and individual adult inpatient hospital improvements have been noted. Between 2017 and 2020, Northwell's overall system HCAHPS “Quiet at Night” Top Box performance increased by 4.7, improving 30 percentile rank points when compared to the Press Ganey national database. This case study outlines Northwell's pragmatic patient-centered strategy and examines the unanticipated impact of limited visitation due to COVID-19 on this HCAHPS measure.

Patient centricity: lip service or genuine commitment? A qualitative examination of the pharmaceutical industry

PurposeThe purpose of this study is two-fold: first, to identify the degree of adoption of patient centricity in the pharmaceutical industry and second, to understand how the industry operationalizes this strategy. It is an important shift in the industry because of its central focus on the patient.Design/methodology/approachA content analysis was used based on publicly available documentation that includes industry publications, company and brand websites and clinical trial publications to identify the frequency of words used to describe patient centricity.FindingsThe key finding of this study is that the leading pharmaceutical firms overwhelmingly use patient support/access programs as the primary method of implementing patient centric strategies.Research limitations/implicationsFuture research is needed to identify what impact these strategies have on patients; and whether or not these strategies have an impact on lowering drug prices and improved clinical outcomes for patients.Practical implicationsFuture research is needed to identify what impact these strategies have on patients; and whether or not these strategies have an impact on lowering drug prices and improved clinical outcomes for patients. Limitations include the reliance on publicly available documentation.Social implicationsPharmaceutical firms need to be aware that their publically available profile suggests a one-dimensional approach to patient centricity and this may influence the way patients, physicians and policymakers view their attitudes toward patients. This study is the first to systematically examine the activities of leading pharmaceutical firms with respect to the adoption and implementation of patient-centric strategies in a comprehensive fashion.Originality/valueThis study is the first to systematically examine the activities of leading pharmaceutical firms with respect to the adoption and implementation of patient-centric strategies in a comprehensive fashion.