Provider Satisfaction Research Articles

Implementation of Episcissors-60 for Prevention of Obstetric Anal Sphincter Injuries (OASIS) in a Centre with Low Episiotomy Rates

ObjectifCette étude avait pour objectif de déterminer si l’adoption des ciseaux Episcissors-60 à l’unité des naissances diminuerait la fréquence des lésions obstétricales du sphincter anal (LOSA). MéthodeUne étude sur l’amélioration de la qualité pré- et post-intervention a été menée pour la période du 1er avril 2020 au 31 mars 2021. Toutes les patientes ayant accouché par voie vaginale ont été incluses dans cette étude. Tous les fournisseurs de soins qui réalisent des accouchements vaginaux se sont fait offrir une séance de formation. Les ciseaux Episcissors-60 ont été ajoutés aux instruments disponibles à l’unité des naissances. Le critère de jugement principal était le changement de la fréquence des LOSA avant et après l’adoption des ciseaux Episcissors-60. Les critères de jugement secondaires étaient le taux d’épisiotomie avant et après l’adoption de ces ciseaux, le taux d’événements indésirables liés à l’instrument ainsi que le taux de satisfaction et les commentaires des fournisseurs de soins. Les données ont été analysées à l’aide de tests du chi carré, de tests t indépendants et de tests de Mann-Whitney. RésultatsAu total, dans la période à l’étude, il y a eu 1383 accouchements vaginaux avant et 1254 accouchements vaginaux après l’adoption des ciseaux Episcissors-60. Il y a eu une diminution du taux total de LOSA, lequel est passé de 7.37 % à 5.37 % de tous les accouchements vaginaux après l’adoption des ciseaux Episcissors-60 (P = 0,037). Le taux d’épisiotomie était de 11.42 % avant et de 9.97 % après l’adoption des ciseaux Episcissors-60 (P = 0.228). Le taux de LOSA chez les femmes ayant subi une épisiotomie était de 12.02 % avant et de 13.60 % après l’adoption des ciseaux Episcissors-60 (P = 0.421). ConclusionBien que l’adoption des ciseaux Episcissors-60 ait été associée à une diminution statistiquement significative du taux total de LOSA, il n’y avait aucune différence du taux de LOSA dans le sous-groupe d’épisiotomie. Par conséquent, la réduction du taux total de LOSA dans cette étude ne peut pas être attribuée à l’utilisation des ciseaux Episcissors-60.

The Role of the Advanced Practice Provider in a Subspecialty Practice: Satisfaction and Professionalism, Including COVID-19 Impacts.

The advanced practice provider collaborates with other clinicians and works to educate, advocate, and increase access for patients in the clinical setting. Research has shown that advanced practice providers working collaboratively with physicians yield improved quality of care and outcomes; however, the current level of understanding of this role in gastroenterology has not been explored in detail. Across two academic institutions, we conducted 16 semi-structured interviews to examine how the environment of the gastroenterology department aligns with the professional satisfaction of its advanced practice providers. Thematic saturation was achieved, revealing four themes: (1) productivity of the working relationship; (2) inconsistent understandings of the advanced practice provider role in clinical care; (3) mixed advanced practice provider experience relating to colleague support; and (4) autonomy impacts satisfaction. These themes highlight not only a reasonable degree of advanced practice provider satisfaction, but also the need to engage with colleagues regarding the advanced practice provider role in care to allow for better integration into the overall gastroenterology healthcare team. The results from different institutions suggest the need to interview gastroenterology advanced practice providers in different settings to better understand whether similar themes exist.

Remote diagnostic imaging using artificial intelligence for diagnosing hip dysplasia in infants: Results from a mixed-methods feasibility pilot study.

Infant hip dysplasia or Developmental Dysplasia of the Hip (DDH) occurs in 1-2% of births worldwide and leads to hip arthritis if untreated. We sought to evaluate the feasibility of implementing an artificial intelligence-enhanced portable ultrasound tool for infant hip dysplasia (DDH) screening in primary care, through determining its effectiveness in practice and evaluating patient and provider feedback. A US-FDA-cleared artificial intelligence (AI) screening device for DDH (MEDO-Hip) was added to routine well-child visits from age 6 to 10 weeks. A total of 306 infants were screened during a 1-year pilot study within three family medicine clinics in Alberta, Canada. Patient and provider satisfaction were quantified using the System Usability Survey (SUS), while provider perceptions were further investigated through semi-structured interviews. Provider and user surveys commonly identified best features of the tool as immediate diagnosis, offering reassurance/knowledge and avoiding travel, and noted technical glitches most frequently as a barrier. A total of 369 scans of 306 infants were performed from Feb 1, 2021 until Mar 31, 2022. Eighty percent of hips scanned were normal on initial scans, 14% of scans required a follow-up study in the primary care clinic, and DDH cases were identified and treated at the expected 2% rate (6 infants). It is feasible to implement a point-of-care ultrasound AI screening tool in primary care to screen for infants with DDH. Beyond improved screening and detection, this innovation was well accepted by patients and fee-for-service providers with a culture and history of innovation.

Virtual prenatal visits associated with high measures of patient experience and satisfaction among average-risk patients: a prospective cohort study

BackgroundVirtual visits have the potential to decrease barriers to prenatal care stemming from transportation, work, and childcare concerns. However, data regarding patient experience and satisfaction with virtual visits remain limited in obstetrics. To address this gap, we explore average-risk pregnant women’s experiences with virtual visits and compare satisfaction with virtual vs. in-person visits as a secondary aim.MethodsIn this IRB-approved, prospective cohort study, we surveyed pregnant women after their first virtual visit between October 7, 2019 and March 20, 2020. Using heterogeneous purposive sampling, we identified a subset of respondents with diverse experiences and opinions for interviews. For comparison, Consumer Assessment of Healthcare Providers and Systems (CAHPS) satisfaction data were collected after in-person visits during the study timeframe from a control cohort with the same prenatal providers. Logistic regression controlling for age, previous pregnancies, and prior live births compared satisfaction data between virtual and in-person visits. Other quantitative survey data were analyzed through descriptive statistics. Free text survey responses and interview data were analyzed using content analysis.ResultsNinety five percent (n = 165/174) of surveys and 90% (n = 18/20) of interviews were completed. Most participants were Caucasian, married, and of middle to high income. 69% (114/165) agreed that their virtual appointment was as good as in-person; only 13% (21/165) disagreed. Almost all (148/165, 90%) would make another virtual appointment. Qualitative data highlighted ease of access, comparable provider-patient communication, confidence in care quality, and positive remote monitoring experiences. Recognizing these advantages but also inherent limitations, interviews emphasized interspersing telemedicine with in-person prenatal encounters. CAHPS responses after in-person visits were available for 60 patients. Logistic regression revealed no significant difference in three measures of satisfaction (p = 0.16, 0.09, 0.13) between virtual and in-person visits.ConclusionsIn an average-risk population, virtual prenatal visits provide a patient-centered alternative to traditional in-person encounters with high measures of patient experience and no significant difference in satisfaction. Obstetric providers should explore telemedicine to improve access – and, during the ongoing pandemic, to minimize exposures – using patients’ experiences for guidance. More research is needed regarding virtual visits’ medical quality, integration into prenatal schedules, and provision of equitable care for diverse populations.

MP61-20 NEW TELEMEDICINE PLATFORM FOR TELEMONITORING AND TELEREHABILIZATION IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP)

You have accessJournal of UrologyCME1 Apr 2023MP61-20 NEW TELEMEDICINE PLATFORM FOR TELEMONITORING AND TELEREHABILIZATION IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP) Sabrina De Cillis, Daniele Amparore, Federico Piramide, Enrico Checcucci, Michele Sica, Alberto Piana, Juliette Meziere, Edoardo Cisero, Gabriele Volpi, Davide Zamengo, Giovanni Busacca, Federica Pini, Dalia Cidda, Cecilia Gatti, Angelo Giordano, Anca Georgiana Mesterca, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Sabrina De CillisSabrina De Cillis More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Federico PiramideFederico Piramide More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Michele SicaMichele Sica More articles by this author , Alberto PianaAlberto Piana More articles by this author , Juliette MeziereJuliette Meziere More articles by this author , Edoardo CiseroEdoardo Cisero More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Davide ZamengoDavide Zamengo More articles by this author , Giovanni BusaccaGiovanni Busacca More articles by this author , Federica PiniFederica Pini More articles by this author , Dalia CiddaDalia Cidda More articles by this author , Cecilia GattiCecilia Gatti More articles by this author , Angelo GiordanoAngelo Giordano More articles by this author , Anca Georgiana MestercaAnca Georgiana Mesterca More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been demonstrated how early postoperative monitoring and rehabilitation protocols provide better recovery of continence and erectile function in patient underwent RARP, but their adoption is limited by the lack of human resources and local services. The aim of this research was to investigate patient and providers satisfaction in the use of a new telemedicine (TM) platform designed for telemonitoring and telerehabilitation of patient undergoing RARP. METHODS: We worked with software engineers to modify and implement the existing MAIA TM platform (ab medica s.p.a.). The TM system consists of an online platform that enables the acquisition, management and archiving of perioperative data and makes it possible to define a treatment plan and monitor the clinical response of rehabilitation activities. By means of an App for SmartPhone and Tablet devices, it is possible to receive notifications for medication and/or rehabilitation exercises and to upload information for monitoring clinical parameters (such as validated questionnaires or PAD tests). Patients undergoing RARP at our institution in September 2022 who had access to the Internet were included in this first part of the study. Patient satisfaction was measured using the Telemedicine Satisfaction Questionnaire (TSQ; range 1-5) and a visual analogue scale (VAS; range 0-100) after 30 days of use. Technical problems and platform/app malfunctions were recorded. RESULTS: 28 patients and 3 providers were enrolled in this first phase of the study. Patients and providers mean (SD) VAS satisfaction scores were 88.7 (17.2) and 82.2 (11.2), respectively. The mean (SD) TSQ score was 4.6 (0.4), all 28 patients reported they would use this new telemedicine platform again and would recommend it to other people. 10/28 (35.7%) patients reported App technical issues, namely 6 (21.4%) notification malfunctions and 4 (14.2%) online questionnaires filling failures. All these issues were easily solved by changing the smartphone's accessibility settings. Providers reported no technical malfunctions of the online MAIA platform. CONCLUSIONS: Our new TM MAIA platform specifically designed for telemonitoring and telerehabilitation of patients undergoing RARP appears to be user-friendly and shows a high level of satisfaction among both patients and providers. The prosecution of this study will be necessary to evaluate the long-term satisfaction and clinical effectiveness of this TM platform. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e860 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sabrina De Cillis More articles by this author Daniele Amparore More articles by this author Federico Piramide More articles by this author Enrico Checcucci More articles by this author Michele Sica More articles by this author Alberto Piana More articles by this author Juliette Meziere More articles by this author Edoardo Cisero More articles by this author Gabriele Volpi More articles by this author Davide Zamengo More articles by this author Giovanni Busacca More articles by this author Federica Pini More articles by this author Dalia Cidda More articles by this author Cecilia Gatti More articles by this author Angelo Giordano More articles by this author Anca Georgiana Mesterca More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

Provider Satisfaction With Artificial Intelligence–Based Hand Hygiene Monitoring System During the COVID-19 Pandemic: Study of a Rural Medical Center

ObjectiveThe objectives of this study were to investigate providers’ attitudes toward an artificial intelligence (AI)–based hand hygiene monitoring system and to examine the relationship between provider well-being and satisfaction with the usage of that system. MethodsA self-administered questionnaire was mailed to 48 health care providers (ie, physicians, registered nurses, and other providers) at a rural medical center in north Texas between September and October 2022. In addition to descriptive statistics, Spearman's correlation test was conducted to discern the relationship between provider satisfaction with the usage of the AI-based hygiene monitoring system and their well-being. A Kendall's tau correlation coefficient test was utilized to assess the correlation between subgroup demographics and survey questions. ResultsWith a 75% response rate (n = 36), the providers reported sufficient satisfaction with monitoring system usage and that AI directly affects provider well-being. Providers with more years of experience and younger than 40 years of age reported significantly higher satisfaction with AI technology in general and considered the amount of time that they spent on AI-related tasks as interesting compared with their counterpart providers. ConclusionThe findings suggest that higher satisfaction with the AI-based hygiene monitoring system was related to greater provider well-being. Providers sought successful implementation of an AI-based tool that met their expectations, but such implementation required marked levels of consolidation to ensure that it fits within the existing workflows and was accepted by users.

A Pilot of Digital Whiteboards for Improving Patient Satisfaction in the Emergency Department: Nonrandomized Controlled Trial.

Electronic paper (E-paper) screens use electrophoretic ink to provide paper-like low-power displays with advanced networking capabilities that may potentially serve as an alternative to traditional whiteboards and television display screens in hospital settings. E-paper may be leveraged in the emergency department (ED) to facilitate communication. Providing ED patient status updates on E-paper screens could improve patient satisfaction and overall experience and provide more equitable access to their health information. We aimed to pilot a patient-facing digital whiteboard using E-paper to display relevant orienting and clinical information in real time to ED patients. We also sought to assess patients' satisfaction after our intervention and understand our patients' overall perception of the impact of the digital whiteboards on their stay. We deployed a 41-inch E-paper digital whiteboard in 4 rooms in an urban, tertiary care, and academic ED and enrolled 110 patients to understand and evaluate their experience. Participants completed a modified Hospital Consumer Assessment of Health Care Provider and Systems satisfaction questionnaire about their ED stay. We compared responses to a matched control group of patients triaged to ED rooms without digital whiteboards. We designed the digital whiteboard based on iterative feedback from various departmental stakeholders. After establishing IT infrastructure to support the project, we enrolled patients on a convenience basis into a control and an intervention (digital whiteboard) group. Enrollees were given a baseline survey to evaluate their comfort with technology and an exit survey to evaluate their opinions of the digital whiteboard and overall ED satisfaction. Statistical analysis was performed to compare baseline characteristics as well as satisfaction. After the successful prototyping and implementation of 4 digital whiteboards, we screened 471 patients for inclusion. We enrolled 110 patients, and 50 patients in each group (control and intervention) completed the study protocol. Age, gender, and racial and ethnic composition were similar between groups. We saw significant increases in satisfaction on postvisit surveys when patients were asked about communication regarding delays (P=.03) and what to do after discharge (P=.02). We found that patients in the intervention group were more likely to recommend the facility to family and friends (P=.04). Additionally, 96% (48/50) stated that they preferred a room with a digital whiteboard, and 70% (35/50) found the intervention "quite a bit" or "extremely" helpful in understanding their ED stay. Digital whiteboards are a feasible and acceptable method of displaying patient-facing data in the ED. Our pilot suggested that E-paper screens coupled with relevant, real-time clinical data and packaged together as a digital whiteboard may positively impact patient satisfaction and the perception of the facility during ED visits. Further study is needed to fully understand the impact on patient satisfaction and experience. ClinicalTrials.gov NCT04497922; https://clinicaltrials.gov/ct2/show/NCT04497922.

Healthcare Providers' Experience Using Telehealth During the Onset of the COVID-19 Pandemic in a Predominantly Rural Patient Base: An Online Survey.

COVID-19 led to the rapid adoption of telemedicine with a significant spike in the literature concerning the patients' perspective of its use. The providers' perspective has been less well studied. Med Center Health is a healthcare network that provides services in 10 southern Kentucky counties that are home to over 300,000 people with approximately 61% of this population living in areas defined as rural. The goal of this article was to compare the experience of providers serving a predominantly rural population to their patients and compare the experience of providers between each other based on the obtained demographic data. An online electronic survey was developed and sent out from July 13th, 2020 to July 27th, 2020 for completion to the 176 physicians of the Med Center Health Physician group. The survey gathered basic demographic information, telemedicine use during COVID-19, and perceptions of telemedicine use during and the role of telemedicine after COVID-19. Perceptions of telemedicine were gauged using Likert and Likert-style questions. Cardiology provider responses were compared to the previously published patient responses. Differences between providers were also analyzed based on the demographic data obtained. Fifty-eight providers responded to the survey with nine providers indicating that they did not use telemedicine during COVID-19. Significant differences between eight cardiologists' and cardiology patients' perceptions of telemedicine visits were seen for internet connectivity (p <0.001), privacy (p = 0.01), and clinical exam (p < 0.001) with cardiologists ranking these as more concerning or worse in all instances. These results continued when comparing perceptions of patients' in-person experience and providers' perception of telemedicine visits with significant differences observed with clinical exam (p < 0.001), communication (p =0.048), and overall experience (p = 0.02). No statistically significant differences were seen between cardiologists and other providers. Providers who indicated more than 10 years of practice rated their experience with telemedicine significantly lower in the domains of effective communication (p = 0.004), level of care provided (p = 0.02), thoroughness of clinical exam (p = 0.047), patient comfort discussing concerns (p = 0.04), and overall experience (p = 0.048). Despite this, only three providers indicated that they would not use telemedicine post-pandemic with a majority indicating that they would feel comfortable using telemedicine for follow-up visits and medication refill visits. This is the first study to our knowledge to compare patient and provider satisfaction concerning telemedicine across a wide array of topics using Likert-style and Likert scale questions and the first to investigate the perception of providers who serve a predominantly rural patient base during the COVID-19 pandemic. Similar results have been found in a few previous studies concerning telemedicine being less favorably rated by more experienced providers. Further studies need to be conducted to identify and correct the barriers that exist for providers and the adoption of telemedicine.

Accurate bundle matching and generation via multitask learning with partially shared parameters.

How can we recommend existing bundles to users accurately? How can we generate new tailored bundles for users? Recommending a bundle, or a group of various items, has attracted widespread attention in e-commerce owing to the increased satisfaction of both users and providers. Bundle matching and bundle generation are two representative tasks in bundle recommendation. The bundle matching task is to correctly match existing bundles to users while the bundle generation is to generate new bundles that users would prefer. Although many recent works have developed bundle recommendation models, they fail to achieve high accuracy since they do not handle heterogeneous data effectively and do not learn a method for customized bundle generation. In this paper, we propose BundleMage, an accurate approach for bundle matching and generation. BundleMage effectively mixes user preferences of items and bundles using an adaptive gate technique to achieve high accuracy for the bundle matching. BundleMage also generates a personalized bundle by learning a generation module that exploits a user preference and the characteristic of a given incomplete bundle to be completed. BundleMage further improves its performance using multi-task learning with partially shared parameters. Through extensive experiments, we show that BundleMage achieves up to 6.6% higher nDCG in bundle matching and 6.3× higher nDCG in bundle generation than the best competitors. We also provide qualitative analysis that BundleMage effectively generates bundles considering both the tastes of users and the characteristics of target bundles.

Assessing the impact of a payor-funded embedded clinical pharmacist on patient and provider satisfaction in a private primary care practice.

With expanding roles of clinic-embedded pharmacists comes the need to identify routes for optimization, soliciting and addressing feedback, and justifying the position(s) to the employing institution. Studies have demonstrated the benefit of integrating pharmacists into healthcare teams, but these opportunities remain largely limited to major health systems due to a lack of billing avenues for and familiarity with the services pharmacists can provide. With funding from and partnership with a third-party payor, a pharmacist was incorporated into a private physician-owned clinic to be a resource to the providers and provide comprehensive medication management to patients. Patient and provider experiences were assessed by survey and interview, respectively, utilizing both Likert-scale and free-response questions. The responses were coded, analyzed, and aggregated into themes. The demographic and Likert-scale responses were analyzed using descriptive statistics. Patients reported a high level of satisfaction with the pharmacist's service, indicating that they felt more comfortable managing their medications and that they would recommend the pharmacist to a family member or friend. Provider satisfaction was also high, with providers stating that they found the recommendations by the pharmacist helpful, that the recommendations improved cardiovascular risk factors in their patients with diabetes, and that, overall, they were satisfied with the care provided by the pharmacist. The primary concern from the providers was a lack of understanding regarding how best to reach and utilize the service. Overall, an embedded clinical pharmacist providing comprehensive medication management at a private primary care clinic had a positive impact on both provider and patient satisfaction.

Mobile Integrated Health Interventions for Older Adults: A Systematic Review.

Mobile integrated health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts, and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least 2 independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (5 studies) and immediate emergency department (ED) transports (3 studies). The 3 studies examining subsequent ED visits and 4 studies examining readmission rates reported mixed results. Studies reported low adverse event rates (5 studies), high patient and provider satisfaction (5 studies), and costs equivalent to or less than usual paramedic care (3 studies). There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall health care costs.

Assessment of an integrated psychiatric pharmacy practice within a rural internal medicine clinic

<h2>Abstract</h2><h3>Background</h3> One-fifth of all adults in the United States have a mental health disorder. More than 60% of rural Americans live in a mental health provider shortage area. However, psychiatric pharmacist integration has not been widely used to full capacity at many rural, private institutions. <h3>Objective</h3> To assess the impact of psychiatric pharmacist integration into an outpatient, rural primary care office. <h3>Practice description</h3> A rural health institution that provides both inpatient and outpatient care. <h3>Practice innovation</h3> A psychiatric pharmacist was integrated within the outpatient internal medicine clinic. On referral from the primary care provider, the pharmacist, in consultation with the primary care provider, can make pharmacotherapy and monitoring recommendation and determine time to follow-up. <h3>Evaluation methods</h3> Single-center, retrospective cohort study from July 1, 2018, to May 23, 2022, with 3 main components: (1) patient outcomes using a within-subject comparison; (2) potential revenue from billable services and pharmacist interventions from all encounters September 12, 2019, to May 23, 2022; and (3) provider satisfaction using an adapted, anonymous survey. Descriptive statistics or percentages were used for both primary and secondary end points. A McNemar test was performed for repeated measures of nominal data, and a Wilcoxon matched-pairs signed rank test was used to analyze continuous data. A <i>P</i> value of < 0.05 was considered statistically significant. <h3>Results</h3> A statistically significant increase in guideline-driven treatments was seen after psychiatric pharmacist integration. A statistically significant improvement in Patient Health Questionnaire-9 scores was also seen after pharmacist integration in contrast to standard of care. Provider time and health care utilization also showed positive results after pharmacist integration. A total of $29,600 is estimated to have been billable for pharmacist services, and clinic staff perceptions of pharmacist integration proved positive. <h3>Conclusion</h3> Psychiatric pharmacist integration showed a statistically significant positive impact on patient care in a rural internal medicine outpatient clinic.

Abstract P1-08-01: Virtual molecular and precision medicine (vMAP) clinic to improve access to clinical trials for patients with metastatic breast cancer: an academic-community collaboration

Abstract Background: Despite improved outcomes for patients with metastatic breast cancer (MBC), attributed in part to advancements in precision therapeutics, clinical trial enrollment and genomic testing are relatively underutilized in the community oncology setting. To address this need, we launched a virtual molecular and precision medicine (vMAP) clinic to improve access for patients in our community network. Here we describe the initial results from the virtual clinic initiative. Methods: In 2020, the vMAP clinic was launched to provide real-time access to precision medicine expertise through virtual, email-based consultation directed to a multidisciplinary team. As part of the service, providers contacted vMAP regarding patients with MBC at the time of initial presentation or disease progression. Upon receipt, the vMAP team (including breast medical oncologists, a breast oncology research nurse, a research assistant, and ad hoc consultation from cancer genetics and molecular pathology representatives) engaged in discussion to identify potential clinical trials with slot availability or standard of care (SOC) options and provided recommendations to the referring provider within 72 hours. Relevant patient data and vMAP referral outcomes were recorded. Providers across the community network were surveyed at project onset and after seventeen months. Results: In its first 14-month period (June 2020-July 2021), 47 cases from 16 providers across seven community oncology sites and one academic site were referred to vMAP. A majority (88.6%) of patients had undergone somatic genomic testing (tissue-based, plasma-based, or both) to inform treatment guidance. All cases were screened for available clinical trials as well as SOC options at the time of referral. The average response time to the referring provider with a finalized recommendation was 1.77 days (range 0-5). Forty cases (85.1%) had clinical trial options identified on vMAP pre-screen. Subsequently, 22 patients (46.8%) screened for vMAP recommended clinical trials with 18 (38.3%) initiating enrollment. Of the remaining patients that did not pursue clinical trial screening, 17 (36.2%) started vMAP-recommended SOC treatment, five (10.6%) pursued a different treatment, one (2.1%) was not a candidate for further treatment, and two (4.3%) opted to receive care at a non-affiliated institution, and subsequent treatment information was not available. Reasons that patients did not enroll on trials included trial ineligibility, formal clinical trial screening failure, and patient/provider preference. At project onset, network provider survey results confirmed a previously suggested demand for improvements in processes surrounding genomic testing interpretation and clinical trial enrollment. Post-referral survey results indicated vMAP recommendations and pre-screenings improved the processes surrounding interpretation of genomic testing and clinical trial screening and enrollment, with high rates of referring provider satisfaction. Conclusion: A precision medicine virtual clinic demonstrated an efficient and flexible means to offer real-time interpretation of genomic and molecular test results and identification of appropriate treatment options, including clinical trials when applicable, for patients with MBC. The service highlights an example of an academic-community collaboration model to expand precision medicine and clinical trial access for patients with metastatic breast cancer. Citation Format: Lindsey Mortensen, Jennifer C. Keenan, Elizabeth Abraham, Sarah Padden, Annie Ma, Elyssa Denault, Lianne Ryan, Arielle J. Medford, Leif Ellisen, Joel H. Schwartz, Aditya Bardia, Laura M. Spring. Virtual molecular and precision medicine (vMAP) clinic to improve access to clinical trials for patients with metastatic breast cancer: an academic-community collaboration [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-01.

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

Abstract P645: Lower Satisfaction With Healthcare Providers’ Communication Associated With African Americans Seeking Care From Complementary and Alternative Medicine Providers: The Jackson Heart Study

Introduction: Individuals who use complementary and alternative medicine (CAM) have been found to have a greater sense of agency and control over their health, a goal that mainstream healthcare providers are also encouraged to promote through patient- centered communication. Patient-centered communication helps patients to feel heard, understood, and involved in their health decisions. The relationship between patient-centered communication and the use of CAM by African Americans has not been previously described. Hypothesis: African Americans who report less satisfaction with their healthcare providers’ communication will be more likely to seek CAM providers. Methods: This was a secondary analysis of data from the Jackson Heart Study, a longitudinal cohort study of African Americans in the Jackson, Mississippi metropolitan area. We performed a cross-sectional analysis of annual follow up data collected between 2004 and 2006. The exposure variables included participants’ satisfaction with their healthcare providers’ communication, which was captured by four items, which asked: “How often did your doctor or other healthcare providers listen carefully to you/explain things in a way you could understand/show respect for what you had to say/spend enough time with you.” These items were summed into a provider communication satisfaction index, with higher scores representing greater satisfaction. The outcome variables included whether the respondent had seen a CAM provider such as an acupuncturist, faith healer, or person who works with roots/herbs, in the previous year. Covariates included education, income, medication insurance status, sex, and age. The final analytic sample after listwise deletion was 2,999. Results: Few JHS participants reported having sought CAM provider options: 0.53% (95% CI: 0.33, 0.87) of participants reported having seen a person who uses acupuncture, 0.50% (95% CI: 0.30, 0.83) of participants reported having seen a faith healer, and 0.60% (95% CI: 0.38, 0.95) of participants reported having seen a person who deals with roots or herbs in the previous year. The provider communication satisfaction index, sum of the four provider satisfaction measures, ranged from 4 to 16 (mean: 14.84, SD: 2.09, 95% CI: 14.77, 14.92). Participants who indicated higher levels of satisfaction with their healthcare providers’ communication had lower odds of having seen a person who works with roots or herbs in the previous year (OR: 0.83, 95% CI: 0.70, 0.99, p= 0.036). Associations between the provider communication index and use of other forms of CAM (i.e, faith healing, acupuncture) were not statistically significant. Conclusions: Overall, this study indicates that patient satisfaction with provider communication is associated with African American patients’ exploration of care from CAM providers, particularly those who work with roots and herbs.

Pengabdian Kepada Masyarakat Melalui Sosialisasi Kesehatan Door To Door Masyarakat Galang Baru

Health is one of the elements of life in building to realize the complete Indonesian human being. The aim of health development is to increase awareness, will and ability to live healthily for everyone in order to achieve the highest level of public health, as an investment for the development of socially and economically productive human resources. The aim of health services is to achieve a level of public health that satisfies the expectations and needs of the community (consumer satisfaction), through effective services by service providers that satisfy the expectations and needs of service providers (provider satisfaction), in service institutions that are delivered efficiently (institutional satisfaction). The interaction of the three main pillars of health services in harmony, harmony and balance, is a combination of the satisfaction of the three parties, and this is a satisfactory health service.

Transitions of Patient Care: A Standardized Tool for Provider Handoff

Lack of communication during care transitions leads to provider dissatisfaction and adverse outcomes. The neurosurgical advanced practice providers (APPs) at this institution reported low satisfaction with handoff between units. The objective of this quality improvement initiative was to develop a standardized handoff process to improve transitions of patient care and increase neurosurgical APP satisfaction. The process included verbal handoff from a neurocritical care APP to a neurosurgery APP and a written transfer summary. High adherence to the initiative was achieved, with improved provider satisfaction post-implementation. This quality improvement initiative demonstrated improved APP satisfaction using a standardized handoff process.

Improvement in Multidisciplinary Provider Rounding (Surgical Rounds) in the Pediatric Cardiac ICU: An Application of Lean Methodology.

Provider-only, combined surgical, and medical multidisciplinary rounds ("surgical rounds") are essential to achieve optimal outcomes in large pediatric cardiac ICUs. Lean methodology was applied with the aims of identifying areas of waste and nonvalue-added work within the surgical rounds process. Thereby, the goals were to improve rounding efficiency and reduce rounding duration while not sacrificing critical patient care discussion nor delaying bedside rounds or surgical start times. Single-center improvement science study with observational and interventional phases from February 2, 2021, to July 31, 2021. Tertiary pediatric cardiac ICU. Cardiothoracic surgery and cardiac intensive care team members participating in daily "surgical" rounds. Implementation of technology automation, creation of work instructions, standardization of patient presentation content and order, provider training, and novel role assignment. Sixty-one multidisciplinary rounds were observed (30 pre, 31 postintervention). During the preintervention period, identified inefficiencies included prolonged preparation time, redundant work, presentation variability and extraneous information, and frequent provider transitions. Application of targeted interventions resulted in a 26% decrease in indexed rounds duration (2.42 vs 1.8 min; p = 0.0003), 50% decrease in indexed rounds preparation time (0.53 vs 0.27 min; p < 0.0001), and 66% decrease in transition time between patients (0.09 vs 0.03 min; p < 0.0001). The number of presenting provider changes also decreased (9 vs 4; p < 0.0001). Indexed discussion duration did not change (1 vs 0.98 min; p = 0.08) nor did balancing measures (bedside rounds and surgical start times) change (8.5 vs 9 min; p = 0.89 and 38 vs 22 min; p = 0.09). Lean methodology can be effectively applied to multidisciplinary rounds in a joint cardiothoracic surgery/cardiac intensive care setting to decrease waste and inefficiency. Interventions resulted in decreased preparation time, transition time, presenting provider changes, total rounds duration indexed to patient census, and anecdotal improvements in provider satisfaction.

The multicenter impacts of an emergency physician lead on departmental flow and provider experiences.

Emergency department (ED) flow impacts patient safety, quality of care and ED provider satisfaction. Throughput interventions have been shown to improve flow, yet few studies have reported the impact of ED physician leadership roles on patient flow and provider experiences. The study objective was to evaluate the impacts of the emergency physician lead role on ED flow metrics and provider experiences. Quantitative data about patient flow metrics were collected from ED information systems in two tertiary hospital EDs and analyzed to compare ED length of stay, EMS hallway length of stay, physician initial assessment time, 72-h readmission and left without being seen rates three months before and following emergency physician lead role implementation. ED flow metrics for adult patients at each site were analyzed independently using descriptive and inferential statistics, t tests and multivariable regression analysis. Qualitative data were collected via surveys from ED providers (physicians, nurses, and EMS) about their experiences working with the emergency physician leads and analyzed for themes about emergency physician leads impact. The number of ED visits was relatively stable pre-post at the Peter Lougheed Centre (Lougheed) but increased pre-post at the Foothills Medical Centre (Foothills). Post-intervention at Lougheed median ED length of stay decreased by 18min (p < 0.001) and at Foothills ED length of stay increased by 8min (p < 0.001). EMS length of stay at Lougheed decreased by 20min (p < 0.001), and at Foothills length of stay increased by 17min (p < 0.001). Themes in provider feedback were that emergency physician leads (1) facilitated patient flow, (2) impacted provider workload, and (3) supported patient flow and safety with early assessments, treatments and investigations. In this study, the emergency physician lead impacted ED flow metrics variably at different sites, but important learnings from provider experiences can guide future emergency physician lead implementation.

The emergency nurse responses to triage interruptions and how these responses are perceived by patients: An observational, prospective study

BackgroundHealthcare providers’ responses to triage interruptions in the emergency department affect quality of care. The purposes for this study were to (1) Examine the relationship between nurses’ response to triage interruption and each of, patients’ perceived confidence in nurses’ technical skills, perceived competence of triage nurse, and satisfaction with the triage experience, (2) Examine the relationship between nurses’ response to triage interruption and nurse demographics. MethodsUsing an observational, prospective design, this study was conducted in an adult academic level 1 trauma center. Data collection tools were: The Triage Interruptions Assessment Tool, Triage and Provider Satisfaction and Confidence Survey, and Demographic Questionnaire. ResultsThe number of observed triage interviews is 93. Of them, 66 interviews were interrupted. No significant relationships were found between nurses’ response to the interruption and patients’ perceived confidence in nurses’ technical skills, competence of triage nurse, or satisfaction with triage experience. There were no significant relationships between nurses’ response to triage interruptions and nurses’ demographics. ConclusionsTriage interruptions in the emergency environment are common and most often result in delays in care. In the current study, this has not been shown to affect patients’ satisfaction. Nurses’ individual characteristics did not affect their responses to triage interruptions.