Patient-provider Collaboration Research Articles

Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making

ObjectivesThrough the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. MethodsWe sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. ResultsPatient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = −.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. ConclusionsAutonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. Practical ImplicationsFor providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients’ coping ability and adapt their approach to care based on the patient’s coping capacity.

"It's Like A Partnership": Exploring the Primary Care Experiences and Patient-Defined Goals of People Who Use Drugs.

Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies have identified important aspects of primary care for people who use drugs (PWUD) and have found patient involvement in healthcare decisions and goal-setting to be especially critical. However, there has been limited research describing the primary care goals of PWUD. In harm reduction settings, where it is imperative that PWUD set their own goals, this research gap becomes especially relevant. To explore how PWUD navigate primary care with a focus on understanding their primary care goals. A qualitative study using semi-structured interviews. PWUD currently engaged in primary care at the Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, a harm reduction-based primary care program in New York City. Between June 2022 and August 2022, we conducted 17 semi-structured interviews. Informed by phenomenology, transcripts were coded using both inductive and deductive codes and themes were developed using thematic analysis approaches. Phenomenological analysis identified four core components that, together, created an experience that participants described as "a partnership" between patient and provider: (1) patient-provider collaboration around patient-defined healthcare goals; (2) support provided by harm reduction-based approaches to primary care anchored in incrementalism and flexibility; (3) care teams' ability to address healthcare system fragmentation; and (4) the creation of social connections through primary care. This holistic partnership fostered positive primary care experiences and supported participants' self-defined care goals, thereby facilitating meaningful care outcomes. To best meet the primary care goals of PWUD, these findings underscore the importance of primary care providers and programs facilitating such partnerships through organizational-level support anchored in harm reduction. Future research should explore how these experiences in primary care affect patient health outcomes, ultimately shaping best practices in the provision of high-quality primary care for PWUD.

Medication Management Strategies by Community-Dwelling Older Adults: A Multisite Qualitative Analysis.

Community-dwelling older adults taking 5 or more medications are at risk for medication-related harm. Managing multiple medications is a challenging task for patients and caregivers. Community-dwelling older adults self-manage their medications with minimal healthcare professional supervision. Although organizations, such as the Food and Drug Administration, often issue guidelines to ensure medication safety, how older adults understand and mitigate the risk of harm from medication use in the home environment is poorly understood. We conducted semistructured interviews with community-dwelling older adults 65 years and older who took 5 or more prescription medications to explore medication safety strategies they use. We also compared 2 organizations' medication safety guidelines for areas of concordance and discordance. A total of 28 older adults were interviewed. Four overarching themes of medication management strategies emerged: collaborating with prescribers, collaborating with pharmacists, learning about medications, and safe practices at home. Study findings revealed that older adults followed some of the published guidelines by the 2 government organizations, although there were some areas of discord. Some of the strategies used were unintentionally against the recommended guidelines. For example, older adults tried weaning themselves off their medications without notifying their providers. Older adults and their caregivers in our study used strategies different from those recommended by government organizations in managing medications to enhance drug safety. Patient-provider collaboration and positive patient outcomes can be improved by understanding and respecting strategies older adults use at home. Future studies must effectively incorporate older adults' perspectives when developing medication safety guidelines.

"Treat Them Like a Human Being…They are Somebody's Somebody": Providers' Perspectives on Treating Patients in the Emergency Department After Self-Injurious Behavior.

To understand ED providers' perspective on how to best care for individuals who present to US emergency departments (EDs) following self-injurious behavior, purposive recruitment identified nursing directors, medical directors, and social workers (n = 34) for telephone interviews from 17 EDs. Responses and probes to "What is the single most important thing ED providers and staff can do for patients who present to the ED after self-harm?" were analyzed using directed content analysis approach. Qualitative analyses identified four themes: treat patients with respect and compassion; listen carefully and be willing to ask sensitive personal questions; provide appropriate care during mental health crises; connect patients with mental health care. Participants emphasized treating patients who present to the ED after self-injurious behavior with respect and empathy. Hospitals could incentivize provider mental health training, initiatives promoting patient-provider collaboration, and reimbursement strategies ensuring adequate staffing of providers with time to listen carefully.

Identified gaps and opportunities in perinatal healthcare delivery for women in treatment for opioid use disorder

Background: Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods: Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results: Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions: The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population.

Supporting Goal-Based Collaboration for Hospitalized Children

To increase patient engagement and facilitate patient-provider collaboration, tools that incorporate patients' goals into medical care plans are needed. However, few studies have explored how hospitalized patients set and share goals to communicate with their caregivers and clinical care teams. Even less is known for how pediatric patients experience sharing their goals during hospitalization. This paper presents a technology probe study to characterize how pediatric patients perceive goal-setting, and how goal-sharing affects their collaboration with their caregivers and clinical care teams. We conducted this study with 13 patient families and 4 clinicians. We found that goals set and shared by pediatric patients foster the patients' autonomy to participate in care decision-making, reveal the gaps of understanding between patients and caregivers, support the patients emotionally during patient and care team interaction, and convey the patients' personalities and preferences to the clinical care team. In addition, we recommend design opportunities to support the different ways that patients' goals can foster high-quality patient care. We also discuss how patients' goals impact the tension of shared decisional authority between patients and caregivers, and how goals support pediatric patients transition to self-care.

Using Data to Approach the Unknown

Medical practices have always been data oriented: healthcare providers decisions are based on data, both clinically generated and patient reported. With the increased use of patient-generated health data (PGHD), other types of data are entering providers? practices and influencing patient-provider collaboration. We studied the use of PGHD and its related data practices in the context of fertility, a health concern that is uncertain, complex, and data intensive. We interviewed 14 patients who are facing or have faced challenges to conceive and 5 healthcare providers specialized in infertility. Our findings show that patients and providers use PGHD in different ways but with the common goal of exploring 'the unknown' generated by the uncertainties of fertility. Providers use patients? data in a rational protocol, aiming to identify possible causes of infertility and define a treatment course. Patients use data in a much more emotional way, learning about their bodies while struggling with data interpretation challenges. By analyzing these data practices, we discuss the principles behind their differences and describe how they have individual benefits for each specific group. We then suggest that fertility technologies need to consider such principles, highlight the existing boundary between patients' and providers' data practices, and focus on bridging instead of merging them in order to facilitate collaboration and maintain their independent benefits.

Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project: Phase I Outcomes

BackgroundThis study aimed to improve institutional value-based patient care processes, provider collaboration, and continuous process improvement mechanisms for primary total hip arthroplasties and total knee arthroplasties through establishment of a perioperative orthopedic surgical home. MethodsOn June 1, 2017, an institutionally sponsored initiative commenced known as the orthopedic surgery and anesthesiology surgical improvement strategy project. A multidisciplinary team consisting of orthopedic surgeons, anesthesiologists, advanced practice providers, nurses, pharmacists, physical therapists, social workers, and hospital administration met regularly to identify areas for improvement in the preoperative, intraoperative, and post-anesthesia care unit, and postoperative phases of care. ResultsMean hospital length of stay decreased from 2.7 to 2.2 days (P < .001), incidence of discharge to a skilled nursing facility decreased from 24% to 17% (P = .008), and the number of patients receiving physical therapy on the day of surgery increased from 10% to 100% (P < .001). Press-Ganey scores increased from 74.9 to 75.8 (94th percentile), while mean and maximum pain scores, opioid consumption, and hospital readmission rates remained unchanged (lowest P = .29). Annual total hip arthroplasty and total knee arthroplasty surgical volume increased by 11.4%. Decreased hospital length of stay and increased surgical volume yielded a combined annual savings of $2.5 million across the 9 involved orthopedic surgeons. ConclusionThrough application of perioperative surgical home tools and concepts, key advances included phase of care integration, enhanced data management, decreased length of stay, coordinated perioperative management, increased surgical volume without personnel additions, and more efficient communication and patient care flow across preoperative, intraoperative, and postoperative phases. Level of EvidenceIII Therapeutic.

The association among cancer patients' collaboration with their healthcare providers, self-management and well-being during radiotherapy: An observational, cross-sectional survey.

Patients adapt to cancer through self-management, which requires collaboration between patients and their healthcare providers. We aimed to describe patterns of patient-provider collaboration during radiotherapy and examine associations among patient-provider collaboration, self-management and well-being. An observational, cross-sectional study was conducted at a cancer centre in the province of Ontario, Canada. Cancer patients (N=130) completed a one-time questionnaire during their radiotherapy. The questionnaire assessed three variables: collaboration with healthcare providers, self-management and well-being. Patterns of collaboration were analysed using descriptive statistics. Associations among study variables were assessed through structural equation modelling (SEM). Separate models were tested for patient-nurse and patient-oncologist collaboration. Participants reported greater collaboration with oncologists than with nurses or radiation therapists. Most participants reported no collaboration with other providers within healthcare teams (e.g. social workers, dietitians). SEM revealed different patterns for the patient-nurse and patient-oncologist collaboration models, where collaboration predicted one self-management aspect, and both physical and mental well-being. During radiotherapy, patients collaborated mainly with doctors, nurses and radiation therapists. Collaborative relationships between patients and providers may enhance patient outcomes by fostering their self-management skills. Initiatives to strengthen patient-provider relationships and support self-management should be developed and applied to interprofessional-cancer-care teams. This is the first known study to empirically support the links among patient-provider collaboration, self-management and patient outcomes. The study results can enhance practice, research and education.

4316 Preoperative Goal-setting by Patients is Correlated with Baseline and Not 6-week Outcomes following Total Knee Arthroplasty (TKA)

OBJECTIVES/GOALS: Patient beliefs and goals can facilitate discussion of recovery expectations, patient-provider collaboration and maximization of goal achievement. In this study, we sought to address an evidence gap and examine the association of preoperative self-assessment of goals with preoperative and 6-week knee function and gait speed among total knee arthroplasty (TKA) patients. METHODS/STUDY POPULATION: We conducted a secondary analysis of data from the VERITAS randomized, controlled trial conducted from 11/2016-03/2018 that included adults age ≥ 18 years with scheduled and completed unilateral TKA followed by post-surgical physical therapy. Patients rated their ability to perform various activities of daily living goals scaled from 0 (unable to perform) to 10 (full performance). Patients were categorized by pre-surgical (baseline) goal rating: low = 0-2, intermediate = 3-4, and high = 5-10. Outcomes including gait speed and the KOOS were assessed within 10 days prior to surgery and 6-weeks post-surgery. Descriptive statistics and outcomes were compared for patients by preoperative goal rating using Chi-square or Fisher’s exact tests and ANOVA or Kruskal-Wallis tests as appropriate. RESULTS/ANTICIPATED RESULTS: Of 288 patients (mean age 65±8; 62.5% women; 82% white), 102 had a low goal rating (GR), 86 intermediate, and 99 high. Patients with low GR preoperatively generally had lower baseline mean scores than intermediate and high GR patients, respectively, on the KOOS (33.9/35.6/39.8; p&lt;0.001) and lower gait speed (m/s) compared to intermediate and high GR patients at baseline (0.9/1.1/1.0; p = 0.009). The low, intermediate, and high GR groups, respectively, showed no difference across mean KOOS scores (61.0/61.2/61.9; p = 0.63) or gait speed (m/s) (1.0/1.0/1.0, p = 0.33) at 6 weeks postoperative. DISCUSSION/SIGNIFICANCE OF IMPACT: In this study, adults who perceived greater difficulty with a pre-selected activity goal, exhibited lower function prior to TKA but showed no differences in function 6-weeks after surgery. Follow-up studies will describe the association between goal-setting preoperatively and patient goal attainment and satisfaction following surgery.

Patient-centred care in the context of pharmacy consultations: A qualitative study with patients and pharmacists in Malaysia.

Patient-centred care (PCC) has been increasingly recognized as the standard in current health care, especially when it comes to health communication between patients and health care professionals. The evidence suggests that PCC could potentially improve medication-related outcomes such as medication adherence, disease self-management, and patient-provider relationships. Pharmacists are strategically positioned in the health care system to provide medication management to patients. However, there is a paucity of research regarding PCC in pharmacist-patient consultations. This study aimed to explore the views and experiences of pharmacists and patients on the important aspects of a PCC consultation. A semistructured interview study was conducted among 17 patients and 18 pharmacists in three tertiary hospitals in Malaysia. All interviews were audiotaped and transcribed verbatim. Themes were developed using a constant comparison approach and thematic analysis. Five main themes emerged from the data, namely, achieving mutual understanding, recognizing individuality, communication style, information giving, and medication decision making. For both pharmacists and patients, a PCC consultation should promote mutual understanding and non-judgmental discussions. Communication was an important element to bridge the gap between patients' and pharmacists' expectations. Patients emphasized the importance of emotional aspects of the consultation, while pharmacists emphasized the importance of evidence-based information to support patient engagement and information needs. Comparison of pharmacists' and patients' views provided insight towards important aspects of PCC in pharmacist-patient consultations. It was suggested that PCC is not a one-sided approach but rather a patient-provider collaboration to optimize the consultation. Further research can be done to improve the integration of PCC in the local health care context, including pharmacist consultations.

Examining Opportunities for Goal-Directed Self-Tracking to Support Chronic Condition Management.

Although self-tracking offers potential for a more complete, accurate, and longer-term understanding of personal health, many people struggle with or fail to achieve their goals for health-related self-tracking. This paper investigates how to address challenges that result from current self-tracking tools leaving a person's goals for their data unstated and lacking explicit support. We examine supporting people and health providers in expressing and pursuing their tracking-related goals via goal-directed self-tracking, a novel method to represent relationships between tracking goals and underlying data. Informed by a reanalysis of data from a prior study of migraine tracking goals, we created a paper prototype to explore whether and how goal-directed self-tracking could address current disconnects between the goals people have for data in their chronic condition management and the tools they use to support such goals. We examined this prototype in interviews with 14 people with migraine and 5 health providers. Our findings indicate the potential for scaffolding goal-directed self-tracking to: 1) elicit different types and hierarchies of management and tracking goals; 2) help people prepare for all stages of self-tracking towards a specific goal; and 3) contribute additional expertise in patient-provider collaboration. Based on our findings, we present implications for the design of tools that explicitly represent and support an individual's specific self-tracking goals.

SURROGATES’ DECISION-MAKING CONFIDENCE AND COLLABORATIVE WILLINGNESS ON THE POST: THE ROLE OF SOCIAL NORMS

When patients become incapacitated due to illness or frailty, “surrogates” work with patients’ providers to make medical decisions on their behalf. In surrogate decision-making situations, surrogates’ decision-making confidence predicts collaborative willingness, or the extent to which they are willing to work with the patient’s providers when making decisions (Spalding & Edelstein, under review). In an attempt to explain this finding, the current study examined whether perceived social norms for patient-physician collaboration and another psychological variable, consideration of future consequences, mediated the relation between decision-making confidence and collaborative willingness. Participants (n= 172) from Amazon’s Mechanical Turk completed self-report measures and a hypothetical surrogate decision-making task. A parallel multiple mediation analysis using 5000 bootstrapped samples with the PROCESS macro (Hayes, 2013) was conducted. The overall model explained 43.4% of the variance in collaborative willingness, F(4, 166) = 9.59, p< .001. There was a significant indirect effect of decision-making confidence on collaborative willingness through perceived social norms (b= .068, SE= .034, 95% CI [.014, .154]). There was not a significant indirect effect through consideration of future consequences. After including the significant indirect path through perceived social norms, the direct effect (b= .348, p< .001) of decision-making confidence on collaborative willingness was reduced (b= .243, p= .003). Thus, perceptions of social norms partially accounted for the relation between decision-making confidence and collaborative willingness. This finding illustrates how social perceptions of patient-provider collaboration can facilitate desirable medical decision-making behaviors, such as collaboration.

Patient–provider perspectives on self‐management support and patient empowerment in chronic care: A mixed‐methods study in a rural sub‐Saharan setting

AimTo explore how provision of self‐management support to chronically‐ill patients in resource‐limited settings contributes to patient empowerment in chronic care.DesignConcurrent descriptive mixed methods research.MethodsA survey of 140 patients with chronic conditions administered at four time‐points in 12 months. We conducted 14 interviews and four focus‐group discussions with patients (N = 31); 13 healthcare provider interviews; and observations of four patient‐support group meetings. Data were collected between April 2016 ‐ May 2017 in rural Malawi. Qualitative data were analysed using a thematic approach and descriptive statistical analysis performed on survey data.ResultsHealthcare professionals facilitated patient empowerment through health education, although literacy levels and environmental factors affected self‐management guidance. Information exchanged during patient–provider interactions varied and discussions centred around medical aspects and health promoting behaviour. Less than 40% of survey patients prepared questions prior to clinic consultations. Health education was often unstructured and delegated to non‐physician providers, mostly untrained in chronic care. Patients accessed psychosocial support from volunteer‐led community home‐based care programmes. HIV support‐groups regularly interacted with peers and practical skills exchanged in a supportive environment, reinforcing patient's self‐mangement competence and proactiveness in health care.ConclusionFor optimal self‐management, reforms at inter‐personal and organizational level are needed including; mutual patient‐provider collaboration, diversifying access to self‐management support resources and restructuring patient support‐groups to cater to diverse chronic conditions.ImpactOur study provides insights and framing of self‐management support and empowerment for patients in long‐term care in sub‐Saharan Africa. Lessons drawn could feed into designing and delivering responsive chronic care interventions.

Identifying and Planning for Individualized Change: Patient-Provider Collaboration Using Lightweight Food Diaries in Healthy Eating and Irritable Bowel Syndrome.

Identifying and planning strategies that support a healthy lifestyle or manage a chronic disease often require patient-provider collaboration. For example, people with healthy eating goals often share everyday food, exercise, or sleep data with health coaches or nutritionists to find opportunities for change, and patients with irritable bowel syndrome (IBS) often gather food and symptom data as part of working with providers to diagnose and manage symptoms. However, a lack of effective support often prevents health experts from reviewing large amounts of data in time-constrained visits, prevents focusing on individual goals, and prevents generating correct, individualized, and actionable recommendations. To examine how to design photo-based diaries to help people and health experts exchange knowledge and focus on collaboration goals when reviewing the data together, we designed and developed Foodprint, a photo-based food diary. Foodprint includes three components: (1) A mobile app supporting lightweight data collection, (2) a web app with photo-based visualization and quantitative visualizations supporting collaborative reflection, and (3) a pre-visit note communicating an individual's expectations and questions to experts. We deployed Foodprint in two studies: (1) with 17 people with healthy eating goals and 7 health experts, and (2) with 16 IBS patients and 8 health experts. Building upon the lens of boundary negotiating artifacts and findings from two field studies, our research contributes design principles to (1) prepare individuals to collect data relevant to their health goals and for collaboration, (2) help health experts focus on an individual's eating context, experiences, and goals in collaborative review, and (3) support individuals and experts to develop individualized, actionable plans and strategies.

Association between Asthma Medication Adherence and Patient-Provider Collaboration

Asthma is a significant pediatric public health concern, with 8.3% of children in the U.S. diagnosed with asthma. Pediatric asthma morbidity is consistently linked to medication non-adherence. Medication adherence has been shown to be influenced by patient-provider interactions. The aim of this study is to examine the relationship between medication adherence, using both objective and subjective reports, to patient-provider collaboration in adolescents with poorly controlled asthma. Thirty adolescents ages 12 to 15 were interviewed along with their caregivers using the Family Asthma Management System Scale (FAMSS). Adherence data were collected via pharmacy refill reports and scores on the FAMSS adherence rating subscale. Patient-provider collaboration was assessed using the corresponding subscale from the FAMSS interview. Pearson correlations were conducted to examine the relationships between both measures of adherence and patient-provider collaboration. There was no significant association between adherence measured with pharmacy refills and patient-provider collaboration (r = .27, p = .176). A significant correlation was found between medication adherence, as measured by the FAMSS ratings, and patient-provider collaboration (r = .53, p = .003). These findings suggest that more collaborative patient-provider relationships may be linked to higher medication adherence among adolescents with poorly controlled asthma.

An Overview of Confidence in Diabetes Self- Management among Diabetics in the State of Qatar

Background: Diabetes complications are preventable given a supportive environment. Managing diabetes daily requires confidence which can be effectively done with effective support system. The information and health services received by diabetics are vital to empowerment as it enables them to make correct choices for better outcomes. The aims of this study were to examine patients’ confidence in self-managing diabetes and its relationship to the level of information and available diabetes related services received in the State of Qatar. Methods: The study was conducted among 300 diabetic patients through face-to-face interviews using a semi-structured questionnaire between February and May 2015 at healthcare facilities of Hamad Medical Corporation in Qatar. Patient consent to participate was sought. Survey responses were analyzed using frequencies, percentages, Chi-squared and Fisher’s exact tests at 5% level of significance. Results: About 54% of patients reported to have had Type 2 and 31% had Type 1 diabetes. Approximately 32% were treated for complications. Diabetic patients were more likely to gain confidence in managing their diabetes the more frequent they were in contact with hospital specialist consultant (P=.02), foot specialist (P=.03), eye specialist (P=.03) and diabetes coordinator (P <0.000), when provided with diabetes plan (P <,000), and having a contact number to call for any diabetes-related concern (P =,005). Healthcare services available to the patients were a significant help for diabetic patients in coping and confidently managing their diabetes. Conclusion: Better patient-provider collaboration and healthcare system’s provision of medical services were substantially useful to diabetics in developing higher confidence to self-manage diabetes.

Effective communication provides early intervention among Medicare patients

PurposeThe purpose of this paper is to determine the association between patients who talked to their doctor about their risk of falling, or occurrence of balance problem. This study analyzed a secondary data set based on the Medicare Health Outcomes Survey (HOS) for the Medicare Advantage patients of 65 years and older. This study guided by two hypotheses that: patients who talked to their doctor about falling or balance problem are more likely to have fallen in the past than those who did not talk to their doctor about their fall risk; and patients talking to their doctor about a fall or balance problem are more likely to receive an early intervention such as patient education to prevent a future fall.Design/methodology/approachThis study utilized a secondary data set to test its hypotheses. The Centers for Medicare and Medicaid Services (CMS) is dedicated to monitoring the quality of care provided to Medicare population in a managed care setting. Inter-University Consortium for Political and Social Research conducts the HOS to measure outcomes of quality improvement interventions developed by CMS in collaboration with the National Committee for Quality Assurance for Medicare Advantage Organizations (MAOs). The measures are focused on assessing the physical functioning and mental health being of Medicare beneficiaries and are aligned with reporting evidence of standards of care. Medicare HOS is administered in each Spring surveying a random sample of Medicare beneficiaries from MAOs that have a minimum of 500 enrollees; the cohort is surveyed again two years later as a follow-up measurement.FindingsReporting of a fall or balance problem is a critical component in fall prevention strategies. This study analyzed the distribution of beneficiaries who talked with their doctor about a fall or balance problem to understand if personal disposition (i.e. social class – educational level, gender, and race) would have been a factor in patients communicating with their doctor about their risk factors. The study found that 67.77 percent of patients who talked with their doctor about a fall or balance problem have at least a high school education compared with 32.23 percent who have less than a high school education or GED.Research limitations/implicationsAll patients who responded to the survey and fulfilled the inclusion criteria were included in the study. Therefore, the data presented a limitation due to a self-report of no doctor visits, which could indicate inopportunity for provider-patient communication to take place. Additionally, such an information on fall or balance problem, including actual fall occurrence in the past 12 months, was based on self-report that could present inaccuracy since the elderly population tend to have diminished or poor memory, which may also be problematic.Practical implicationsAlthough this specific interaction starts with patient reporting of a health problem such as a fall or balance problem, provider must take a proactive approach in deploying prevention strategies, such as to conduct a comprehensive fall-risk assessment regardless of a report of a fall history by the patient. Further investigation of this study is recommended to ascertain pre-dispositional factors that affect patient communication, in order to address any barriers that could impede patient-provider collaboration. Nonetheless, enhancing patient-provider communication is fundamental to any quality intervention strategies such as fall prevention.Social implicationsAnother key finding in this study is that patient communication facilitates fall prevention. Patients who talked to their doctor about their fall or gait problem were provided with patient education on how to prevent falls by their doctor. The provider is informed on patient’s balance problem, which leads to further evaluation of patient health status in order to identify other related factors since a comprehensive fall-risk assessment would have been likely conducted providing adequate information beyond the fall occurrence. This affirms the need for provider-patient communication to serve as catapult for effective care coordination, which is effectual in any intervention strategies.Originality/valueFall prevention is increasingly drawing attention and gaining momentum among healthcare organizations (including non-managed care) since falls and fall-related injuries are easily preventable (Lach et al., 2011). Efforts that can identify and accurately analyze patient health status, including intrinsic and extrinsic risk factors, promote effective interaction between patient and provider. This study has shown the positive effect of patient communication in order to allow doctors to effectively intervene (i.e. prevent a future fall) through the provision of patient education.

How Does Patient-Provider Collaboration Affect Patient Self-Management and Outcomes During Radiation Therapy?

How Does Patient-Provider Collaboration Affect Patient Self-Management and Outcomes During Radiation Therapy?

Supporting Patient-Provider Collaboration to Identify Individual Triggers using Food and Symptom Journals.

Patient-generated data can allow patients and providers to collaboratively develop accurate diagnoses and actionable treatment plans. Unfortunately, patients and providers often lack effective support to make use of such data. We examine patient-provider collaboration to interpret patient-generated data. We focus on irritable bowel syndrome (IBS), a chronic illness in which particular foods can exacerbate symptoms. IBS management often requires patient-provider collaboration using a patient's food and symptom journal to identify the patient's triggers. We contribute interactive visualizations to support exploration of such journals, as well as an examination of patient-provider collaboration in interpreting the journals. Drawing upon individual and collaborative interviews with patients and providers, we find that collaborative review helps improve data comprehension and build mutual trust. We also find a desire to use tools like our interactive visualizations within and beyond clinic appointments. We discuss these findings and present guidance for the design of future tools.