Quality Of Patient Outcomes Research Articles

Nursing Wellness in Academic and Clinical Cardiovascular and Stroke Nursing: AScientific Statement From the American Heart Association.

Nursing is an essential part of our health care system workforce. Cardiovascular and stroke nursing represents one of the largest specialty areas requiring expert knowledge and clinical proficiency to ensure safety and quality patient outcomes. To support the growth and sustainability of the various nursing roles in clinical practice, academia, and research, it is vital to attract, engage, mentor, and retain nurses. However, as the health care needs of the nation rise, staff nurses, advanced practice registered nurses, nursing educators, and nurse scientists are experiencing unprecedented demands, and individual wellness and burnout are being more closely examined at both the university and health care system levels. The goal of this scientific statement is to outline the drivers of burnout or intent to leave the profession that impact wellness specific to academic and clinical cardiovascular and stroke nursing and propose system-level interventions to mitigate and support future and current nurse clinicians, nurse educators, and nurse scientists.

Enhancing Workplace Well-being: Unveiling the Dynamics of Leader–Member Exchange and Worker Safety Behavior Through Psychological Safety and Job Satisfaction

BackgroundIn healthcare, ensuring safety is crucial for quality care and patient outcomes. While research links leader–member exchange (LMX) quality to safety behavior, this remains understudied in healthcare. Our study explores LMX's long-term impact on safety behavior, proposing a model that includes the moderated mediating role of psychological safety and job satisfaction in the relationship between LMX and safety behaviors, regarding compliance (SCB) and participation (SPB). By identifying the mechanisms through which LMX influences safety behavior, this study can provide insights into the development of interventions that promote workplace safety and enhance the well-being of healthcare workers. MethodsWe collected data from 325 Algerian healthcare workers across three public hospitals at three points. Through SmartPLS analysis, we used advanced features of Partial Least Squares Structural Equation Modeling (PLS-SEM) alongside PROCESS analysis to evaluate the relationships within our proposed model. ResultsOur analysis found a significant association between higher LMX and increased job satisfaction that positively correlated with enhanced SCB adherence and mediated the LMX–SCB relationship. This relationship was strengthened with high psychological safety. ConclusionOur study emphasizes the crucial role of LMX quality in shaping safety behavior among Algerian healthcare workers, providing insights for cultivating a safety culture in healthcare settings, highlighting the significance of prioritizing LMX, JS, and PS to improve workplace safety and support healthcare worker well-being.

Traumatic brain injury outcomes at the “epicenter of the epicenter” of the united states COVID-19 pandemic amidst ongoing socio-demographic challenges

Abstract Introduction Traumatic brain injury (TBI) poses a significant public health challenge with profound impacts at individual, family, community, and societal levels. Early during the COVID-19 pandemic, the neighborhood of Elmhurst, Queens in New York City was a hotspot dubbed the “epicenter of the epicenter” of the crisis in the United States, requiring major changes in healthcare resource allocation. This study investigates how different phases of the COVID-19 pandemic affected the incidence, severity, and clinical outcomes of TBI in this geographical area. Methods TBI admissions to NYC Health + Hospitals/Elmhurst, a Level 1 Trauma Center, during the first six months of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: pre-pandemic (1/1/19–6/30/19 and 1/1/20–2/29/20) [Group 1], first COVID-19 wave (3/1/20–6/30/20) [Group 2], and second COVID-19 wave (1/1/21–6/30/21) [Group 3]. Univariate analyses were conducted to explore factors potentially associated with TBI outcomes; variables that reached statistical significance (p < 0.05) were included in a binary logistic regression analysis dichotomized into good outcome (discharge to home or acute rehabilitation disposition) and poor outcome (discharge to skilled nursing facility/subacute rehabilitation, hospice, or in-hospital mortality). Results Analysis of 443 TBI patients (median age 56 [range 38, 73]; mean admissions/week 5.6 ± 2.7) demonstrated no significant variance in age (H = 0.92; p = 0.63), sex (χ2 = 1.4, p = 0.51), or ethnicity (χ2 = 17.1; p = 0.07) across groups. Group 2 had significantly fewer weekly admissions (3.9 ± 2.6) compared to Groups 1 (5.9 ± 2.2; p = 0.02) and 3 (6.1 ± 2.9; p = 0.01). Over the course of the pandemic, the proportion of uninsured patients decreased from 15 to 4%, while Medicaid and Medicare coverage rates rose from 25 to 41% and 20% to 28%, respectively (p < 0.001). A binary logistic regression model dichotomized by discharge outcome for all 443 TBI patients confirmed that increasing age (OR = 0.95; 95% CI 0.93–0.97; p < 0.001) and Injury Severity Score (OR = 0.88; 95% CI 0.83–0.93; p < 0.001) were inversely correlated with good outcome, while higher Glasgow Coma Scale (OR = 1.26; 95% CI 1.17–1.36; p < 0.001) was positively correlated. Of particular interest, Black/Hispanic ethnicity (OR = 0.36; 95% CI 0.19–0.66; p = 0.002) and public health insurance (Medicaid/Medicare) coverage (OR = 0.83; 95% CI 0.68–1.00; p = 0.05) were both associated with less favorable outcomes. Neither group designation, patient sex, COVID-19 status, or need for neurosurgical intervention was correlated with outcome (p > 0.05). Conclusion Despite the changes in TBI admission patterns throughout New York City during the COVID-19 pandemic, the quality of patient outcomes at our institution remained relatively consistent across the pandemic’s different phases, as assessed by discharge disposition. However, two important socioeconomic factors—ethnicity and health insurance status—were significantly associated with outcome, underscoring the need for systemic changes to address ongoing disparities in neurotrauma care.

Missed nursing care: An important yet challenging issue

Hospitalized patients have the right to have their needs met and to receive thorough and secure care from the healthcare system. Ensuring the safety and quality of patient outcomes in nursing care poses a significant challenge for nursing personnel and administrators [1]. Missed nursing care is regarded as both an individual and organizational concern, which poses a threat to patient safety when they are deprived of comprehensive care [2]. The shortage of nursing staff, communication barriers among healthcare workers, and inadequate facilities and equipment compel nurses to prioritize certain tasks and make decisions regarding which care to provide or forgo, leading to the omission of certain aspects of care [3]. Missed nursing care is a newly defined concept based on neglect and refers to all the partial and general aspects of the patient's required care that are forgotten or delayed [4].

Exploring the Lived Experiences of Post-basic Nursing Students: Insights into Continuous Learning

Continuous learning in clinical settings is essential for optimum quality of care. This study examines the lived experiences of post-basic nursing students specialising in critical care, emergency care, and peri-operative care in a tertiary university hospital. Using a descriptive phenomenological approach, three focus group interviews were conducted with 23 purposively sampled post-basic critical care nursing students. Four overarching themes emerged from the data analysis: (1) the programme’s benefits to students; (2) feedback on programme implementation; (3) avenues for future improvement; and (4) challenges encountered during the programme. The findings emphasise the critical role of ongoing education in clinical contexts, particularly in post-basic critical care nursing education. Students’ lived experiences underscore the programme’s positive effects on their knowledge, skills, and organisational benefits, emphasising the crucial role of continuous education in enhancing the quality of nursing care. The identified themes offer valuable insights into the advantages, obstacles, and areas needing improvement in post-basic critical care nursing education. They showed the importance of a sustained commitment to continuous learning to ensure the delivery of high-quality care in clinical practice. This study contributes to the existing body of knowledge on nursing education and offers valuable insights for educators, administrators, and policymakers to optimise the training and development of nurses to achieve quality patient outcomes.

Evaluation of hospital quality of care outcomes in a teaching hospital in Ethiopia: a retrospective database study

ObjectivesWe aimed to evaluate hospital mortality rates, readmission rates and length of hospital stay (LOS) among adult medical patients admitted to a teaching hospital in Ethiopia.DesignWe performed a retrospective study...

Postoperative epidural analgesia and outcomes following pediatric bilateral lung and heart-lung transplantation: a retrospective observational study

BackgroundThe value of epidural analgesia in pediatric patients having heart and lung transplant surgery is unknown. We aimed to characterize various quality outcomes in patients who did and did not...

Barriers to Nurse-Patient Communication at Primary Health Centers in Almadina Munawara City, Saudi Arabia

Background: Nurse-patient communication is a unique clinical skill in the healthcare professions that promotes good quality care and patient outcomes. This communication can be disrupted by many barriers that impact the therapeutic relationship and deliver of care. Purpose: The study aims to identify the barriers affecting nurse-patient communication at primary health centers in Almadina Munawara City, Saudi Arabia. Methods: A cross-sectional study was performed among 212 nurses and 214 patients utilizing a self-reporting questionnaire. A version of the same file was then uploaded into NVivo, and data that were coded under all communication barriers including language discordance among patients and healthcare providers (e. g., subtheme: patient prefers a mother tongue speaking doctor), cultural-religious difference and environmental cues between the involved parties to determine their importance in this context as well (see Table 2). Results: The results showed that language, cultural and environmental differences had an extensive influence on how nurses communicated with patients. Key barriers included nurse shortages, limited communication time and low income. Our results suggest that these barriers differ in their effect with language barrier and habitat disturbance being the most important ones. Conclusions: This study concludes that nurse-patient communication is a complex multi-sectional process, constrained by numerous barriers. Strategic intervention aimed at addressing these barriers can strengthen nurse-patient interaction and accelerate patient care. Communication remains a cornerstone in all the best practices of delivering healthcare effectively and keeping patients happy.

Intensive Care Unit Sleep Promotion Bundle: Impact on Sleep Quality, Delirium, and Other Patient Outcomes.

High-quality sleep is important for optimal patient recovery. Sleep deprivation during hospitalization may lead to poor patient outcomes. To examine whether implementation of a sleep promotion bundle in the intensive care unit affects rates of delirium and agitation, restraint use, and length of stay. An evidence-based sleep promotion bundle was developed and implemented in 2 intensive care units in a 1025-bed level I trauma teaching hospital. Deidentified data from the electronic health record were obtained for patients hospitalized before and during the intervention. Data included scores on the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale, and Glasgow Coma Scale; restraint use; and hospital and intensive care unit length of stay. A total of 137 patients during the preintervention period and 149 patients during the intervention period were hospitalized in the intensive care units and met inclusion criteria. A 9-percentage-point decrease in the incidence of delirium from before to during the intervention was found, although it was not statistically significant (P = .07). Significant reductions were found in both intensive care unit (P = .04) and hospital (P = .03) length of stay. A significant decrease was found in Richmond Agitation-Sedation Scale high scores for patients requiring mechanical ventilation (P = .03). No significant differences were found in Richmond Agitation-Sedation Scale low scores, Glasgow Coma Scale scores, or restraint use. Critical care nurses are in an optimal position to implement evidence-based sleep promotion measures. Further research on sleep promotion bundles is needed.

Enhancing Sepsis Outcomes: A 7-Year Multidisciplinary Endeavor.

Regulatory bodies in the United States have implemented quality metrics aimed at improving outcomes for patients with severe sepsis and septic shock. The current study was a quality improvement (QI) project in a community-based academic center aimed at improving adherence to sepsis quality metrics, time to antibiotic administration, and patient outcomes. Electronic health record systems were utilized to capture sepsis-related data. Regular audits and feedback sessions were conducted to identify areas for improvement, with a focus on the timely administration of antibiotics. Interventions included improving access to antibiotics, transitioning from intravenous piggyback to intravenous push formulations, and providing continuous staff education and training. This multidisciplinary QI initiative led to significant improvements in the mortality index, length of stay index, and direct cost index for patients with sepsis. Targeted multidisciplinary QI interventions resulted in improved quality metrics and patient outcomes.

Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study

BackgroundPalliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use.MethodsWe analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex.ResultsOf the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM.ConclusionThe data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.

Lack of associations between hospital rating and outcomes in patients with an acute coronary syndrome

BackgroundPublic reporting of performance data has become a common tool in evaluation of healthcare providers. The rating may be misleading if the association between the measured variables and the outcome...

The Quality Work Life among Nurses Working in Selected Hospitals in Kathmandu

Background: Quality Work Life (QWL) is essential for the long-term resilience of healthcare systems and nurses' Well-Being (WB), despite the fact that there hasn't been much research done in Nepal. Purpose: The main aim of this research study is to examine the QWL among nurses and inspect the association b/t QWL with demographic features among nurses. Methods: To study nurses' QWL, a cross-sectional technique was carried out at the selected tertiary-level of Hospital in Basundhara/Dhapasi, Kathmandu; a non-probability enumerative sampling method was adopted based on the QWL survey. The questionnaire has six categories: sociodemographic data, work environment, management relationships, work conditions, job perception, and support services. Validity and reliability were ensured, and informed consent was obtained in writing. The study had 150 registered nurses enrolled in it, and it received ethical approval. Findings: In this study, researchers utilized descriptive and chi-square tests to examine the level of quality of work life (QWL) among nurses and the association of demographic factors with QWL, However, the results demonstrated that the majority (81.3%) of the nurses experienced a moderate level of QWL. Research Limitation/ Practical Implication: Low generalizability, a small sample size, self-reported bias, a cross-sectional design, and limited data collection techniques are some of the study's limitations. Health organizations should invest in training and development, social support, flexible work, and policies that address the work environment, relationships with management, work conditions, job perception, and support services if they want to improve the QWL of nurses in Kathmandu. It is crucial to take activities that increase output and employee happiness. Originality/Value: The originality and value of this study reside in its assessment of the relationship between QWL, quality patient outcome, and nurse well-being, addressing a significant gap in the literature.

Bridging didactic and clinical in nursing education: An innovative health assessment activity

BackgroundAssessment skills are foundational for nursing education to support quality patient care and outcomes across the lifespan. The aim of this activity was to increase knowledge and confidence in performing age-related focused assessments across the lifespan, recognizing cues to differentiate between potential conditions, and documenting findings appropriately. The Situated Cognitive Theory guided the development of the activity. InnovationFaculty developed a comprehensive review activity of focused assessments across the lifespan using scenarios with low and high-fidelity manikins in a classroom setting. Students completed a pre- and post-survey on their perceptions of knowledge and confidence and suggestions for improvements. ImplicationsThe number of positive responses increased for all questions and demonstrated a statistically significant change in perceived knowledge and confidence from pre- to post-time points. Students reported enjoyment of the hands-on approach and application of course content in a realistic setting. ConclusionOverall, students’ perceived knowledge of lifespan assessments increased and voiced an enhanced connection between readings and patient care. The usage of technology-enhanced scenarios shows the potential to augment student learning in prelicensure nursing curricula.

EXPLORING THE UTILIZATION OF MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) PROGRAMS IN WORKFORCE DEVELOPMENT

Abstract Measuring patient outcomes is a critical component of the HRSA funded Geriatric Workforce Enhancement Programs (GWEPs), which aim to improve the quality of care for older adult patients. In 2019, GWEPs were tasked with aligning patient outcomes with the CMS Merit-based Incentive Payment System (MIPS) program, which incentivizes quality care and patient outcomes. Collecting and using MIPS data effectively can be a challenging task, particularly when done across multiple levels of care. To address these challenges, the National Association of Geriatric Education Centers (NAGEC) created a workgroup to develop advocacy and solutions for patient outcomes. This symposium will discuss the utilization of MIPS as performance metrics across three GWEPs, the challenges in reporting these outcomes, and implications for future policy changes. This symposium’s primary objective is to explore how GWEPs can effectively measure patient outcomes, despite the challenges involved in collecting and utilizing MIPS data. By discussing these challenges and proposing potential solutions, this symposium aims to improve the effectiveness and sustainability of GWEPs, ultimately leading to better outcomes for older adult patients. Overall, measuring patient outcomes is critical for ensuring that older adult patients receive high-quality care that is tailored to their individual needs and preferences. Despite the challenges involved in collecting and utilizing MIPS data, our symposium provides an opportunity to explore potential solutions and advocate for policies that support improved patient outcomes in geriatric care.

Social workers roles in achieving health quality metrics in primary care: a quality improvement case study

ABSTRACT Value-based payment models may improve patient health by targeting quality of care over quantity of health services. Social workers in primary care settings are well-positioned to improve the quality of health services for vulnerable patients by identifying and addressing patients’ social determinants of health. This case study describes a Plan Do Study Act (PDSA) quality improvement approach implemented and refined by social workers to proactively address clinical quality gaps in one family medicine practice. The studied program – entitled Gap Closure Day – was led by a team of social workers to improve quality outcomes of patients. Findings highlight the important roles of social workers as members of health care teams to improve the quality of health services and address health equity.

CAR-T Phenotype and Efficacy Is Impaired By Lymphoma-Associated CD39 + T Cells

Background: Autologous chimeric antigen receptor (CAR) T-cell therapy is standard of care for patients with relapsed or refractory Large B cell Lymphoma (R/R LBCL). Each patient's CAR T product is unique, and the patient-specific determinants of CAR T-cell quality are poorly understood. CD39 is an ectonucleosidase that participates in the conversion of ATP and ADP and is upregulated in cancer. On T-cells, CD39 is expressed on CD4+ Tregs and on exhausted CD8+ T-cells that are prone to apoptosis. Methods: This is a retrospective single-center cohort study (N=72) of patients who received CD19 CAR T-cell therapy for LBCL (axi-cel n=52; tisa-cel n=20). Leukapheresis material was obtained from n=51 patients and flow cytometry was performed to phenotype CD4+ and CD8+ stem-central memory, memory, and effector T-cell subsets (using CCR7 and CD45RO), and for immune checkpoint expression (PD-1, LAG3, TIGIT, and CD39). 10x multiome (ATAC and RNA) single cell sequencing (scRNA-seq) was performed on n=8 leukapheresis products for deeper characterization. Serum metabolomics was performed on paired samples from n=21 patients. 10X Genomics Chromium scRNAseq was also performed on n=57 CAR T-cell infusion products, including n=36 with paired leukapheresis material previously phenotyped by flow cytometry. In vitro CAR T-cells were manufactured from starting patient T-cells and analyzed for CAR T-cell phenotype and function. Results: In the leukapheresis material of patients that did not achieve long-term remission after CAR T-cell therapy, and in those with high tumor burden, we found higher numbers of CD4+CD39+ and CD8+CD39+ T-cells ( Figs. 1 and 2). 10X multiome sequencing confirmed that CD39+ T-cells exhibit characteristics of exhaustion. Recent platinum-based chemotherapy did not affect CD39+ T-cell levels. In n=21 patients with paired serum analyzed by metabolomics, high CD8+CD39+ T-cells associated with reduced metabolites in the inosine-hypoxanthine pathway, which are downstream of the ectonucleotidase function of CD39 (inosine; P=0.006; hypoxanthine P=0.07). Increased numbers of CD39+ T-cells in the starting leukapheresis material translated into manufactured CAR T-cells having less favorable product characteristics, including higher CD39 expression and fewer memory cells in both paired patient samples and in experiments of in vitro CAR T-cell manufacturing. ScRNA-seq of the infused CAR T-cell product revealed differential gene signatures, both globally and in association with response, between axi-cel and tisa-cel CAR T-cell products, highlighting the profound product-specific differences. Nonetheless, both products were adversely affected by high CD39+ T-cells in the leukapheresis material used for manufacture. Conclusions: CD39+ T-cells, found in patients with high lymphoma tumor burden and an unfavourable immunometabolic environment, associate with poor CAR T-cell quality and adverse patient outcomes in R/R LBCL. Strategies are needed to improve patient T-cell quality prior to leukapheresis and/or improve CAR T-cell manufacturing from patients with high levels of exhausted CD39+ T-cells. Figure 1: Progression-free survival (PFS) stratified by leukapheresis CD8+CD39+ T-cells in the leukapheresis product. Blue - below cohort median percentage of CD8+T-cells that are CD39+ (low); Red - above median percentage of CD8+T-cells that are CD39+ (high). P-value by Log-Rank test. Overall survival (not shown) P-value 0.01. Figure 2: Proportion of CD8+CD39+ T-cells found in patients with low or high baseline metabolic tumor volume (MTV) based on a previously established cutoff (Dean et al. Blood Adv. 2020). MTV was measured on the pre-CAR T-cell PET/CT. P-value by T-test. MDJ, XY, and RMA are co-first authors with equal contribution.

Association of Hospitalist Care and Outcomes on an Inpatient Elective Anticancer Therapy Service

Background: Hospitalist care is becoming increasingly common at cancer centers. Here, we assess the impact of oncology hospitalist care on quality outcomes on an inpatient elective anticancer therapy service for patients with leukemia and lymphoma. Methods: On July 26, 2021, the Smilow Cancer Hospital transitioned the elective anticancer therapy team from a hematologic oncologist-led traditional service (TS) to an oncology hospitalist-led service (HS). We compared quality outcomes for patients with leukemia and lymphoma requiring elective anticancer therapy who were admitted during two parallel 18-month periods (TS: July 1, 2018 to December 31, 2019; HS: July 26, 2021 to December 31, 2022). Longitudinal data analysis using mixed linear regression models with random effects for intercept (individual) and slope (time) were used to estimate the association between service and outcome, accounting for patients with multiple admissions reflecting sequential cycles of chemotherapy. The outcomes were length-of-stay (LOS), time from admission to first anticancer therapy administration, and discharge time of day. Models were adjusted for age, sex, race/ethnicity, diagnosis, anticancer therapy type, Severity of Illness index, and total elapsed time since cycle 1/day 1 of the index regimen. Results: The study included 161 patients, 59 from the TS and 102 from the HS. There were 65 patients with leukemia and 96 with lymphoma. No significant differences in median age, sex, race/ethnicity, or severity of illness index between services were observed (p>0.05). The most common anticancer regimen was etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) for lymphoma (TS n=16 (27%); HS n=31 (30%)). For anticancer regimens with a fixed number of treatment days, after adjustment, we observed a significant reduction of length of stay that exceeded one full day (TS=6.09 days (95% CI: 6.09, 6.95 days); HS=3.82 days (95% CI:3.48, 4.16 days); p<0.001), the adjusted mean time from admission to first anticancer therapy administration decreased by 4.12 hours (95% CI: 0.66, 7.59 hours; p<0.001), and the adjusted mean discharge time decreased by 66 minutes (95% CI: 9, 211 minutes; p=0.01) ( Table 1). For those regimens that required variable monitoring for post-treatment methotrexate clearance or tumor lysis syndrome, no significant difference in outcomes was noted (p>0.05). Conclusions: Hospitalist care on an inpatient elective anticancer therapy service was associated with significant improvements in LOS, time from admission to anticancer therapy administration, and discharge time.

Effects of Primary Care-Led, Integrated Palliative Care for Medicare Patients in a Value-Based Model

ContextFaced with a projected shortage of specialized palliative care physicians, scalable palliative solutions are required to better meet the aging population's needs. ObjectivesTo determine whether a multi-site, primary care-led, integrated palliative care model improves clinical, utilization, and economic outcomes. MethodsPropensity score-matched comparison group formed from participants who were Medicare beneficiaries, died January 1, 2021–January 31, 2023, were patients of eight primary care practices that partner with agilon health, and enrolled in palliative care for at least seven days. Each practice operates in a value-based model, where primary care providers (PCPs) take on full-risk for the cost and quality of patient outcomes. Each program includes symptom management, defining goals of care/advance directives, PCP care coordination, and assistance with care transitions if patients enroll in hospice. ResultsFinal sample included 1778 decedents, with 889 in both enrolled and matched cohorts, average age 83. Palliative care is associated with improved patient outcomes from palliative care enrollment until death, including 5.4 more days at home (p < 0.001), 0.4 fewer hospitalizations (p < 0.001), 17% fewer deaths in a hospital (p < 0.001), and $10,393 lower overall healthcare costs (p < 0.001). ConclusionA primary care-led, integrated approach of delivering palliative care within a full-risk model can be an effective care delivery mechanism to meet the healthcare needs of an aging population by impacting patient outcomes and reducing avoidable utilization and cost at the end of life. These findings demonstrate that PCPs in a scaled, full-risk model can simultaneously improve care for patients while reducing costs to the healthcare system.

Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review.

A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.