Values-based Practice Research Articles

MHealth in Physical Therapy Practice: What Consumers Want?

Purpose: Health-care delivery mode system has been evolving over the years. There has been an increase in adoption of mHealth technologies by health-care clients and providers. Physical Therapy and Society Summit (PASS) was sponsored by APTA in 2009. It envisioned current, evolving, and future health care needs that could be addressed by physical therapist. Recent COVID-19 pandemic has modified ways of working and addressing various needs for health care. This has led to adding finding new strategies to establish new normal of functioning. The focus should be on adding value-based practice with the consumers as key stakeholders. Thus, the authors aim to provide a literature review framework for mHealth in physical therapy practice and also understand consumer behavior and what are their wants from this emerging mode of health-care delivery. Methodology: Literature was assessed by comprehensive computerized search from January 2020 to July 2020 form multiple databases. In addition, to increase the search accuracy, reference lists of articles were also searched. Forty-six free; full-text articles, systematic reviews, RCT’s, health policy perspectives, global surveys, and guidelines were included for the literature review frame work. Consumer behavior and needs were assessed using a designed questionnaire through online survey sent through various social platforms. Conclusion: mHealth is a definite evolving change in physical therapy practice. Focus should be on Android-based application for a probable 85% target population. Self-assessments, treatment interventions, activity tracking, and report documentation are the key features consumers look for.

Systematic performance status assessment by primary care providers in patients with advanced cancer and its impact on referral to palliative care and cost in a value-based practice.

6595 Background: Value Based (VB) Care model has been growing in the primary care (PrC) Medicare population, its role in oncology and integration with VB PrC has not been well defined. Key initiatives in VB include reducing hospitalizations by multidisciplinary management of chronic conditions. Earlier Palliative Care (PaC) has shown to favorably impact outcomes. Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is a validated tool used for decision making. Poor PS is associated with worse outcomes and futile end of life care; Guidelines recommend using ECOG-PS to decide on involvement of PaC in patients (pts) with metastatic cancer (mCa). ECOG-PS is subject to significant variability among oncologists and rarely used by PrC providers (PCPs). We created a standardized system for ECOG-PS documentation and monitoring by PCPs in a VB model in a large Medicare Advantage (MA) population with the goal of increasing earlier PaC referrals. Methods: Pts with mCa managed by PCPs in a multi-state MA practice were identified via EMR from February 2021 to September 2021. At every visit, an automated alert asked PCPs to determine pts’ ECOG-PS and for those ≥ 2, recommendation to refer to PaC. PCPs were trained on use of the tool and were given a script to discuss with pts the role of PaC. Hospital admissions as well as total cost of care was measured in pts comanaged by PCP’s & PaC versus those managed by PCPs &Oncology without PaC. Statistical analysis between the groups was done using Pearson's Chi-squared test with Yates' continuity correction. Results: An ECOG-PS was measured in a total of 565 pts with mCa during the study period. Median age was 73 years, 40% were ≥75 yrs. 55% were female. Breast, Prostate, Lung, Colorectal and Gyn ca accounted for 75% cases. ECOG was documented in 97% of patients; 250 (44%) had ECOG ≥ 2, 124 (22%) had ECOG ≥ 3. Of those PaC referral was done by the PCP in 70%, in total 69 patients were comanaged by PC vs 181 who did not. Pts that had PaC involvement were 43% less likely (RR 0.57 [95%CI 0.33,0.98 p = 0.043]) to be admitted compared to patients without PC. Pts without PaC that were admitted had 238% higher admission days per 1,000 pts compared to pts comanaged by PaC. Total medical costs of pts comanaged by PaC was 86% lower after PaC involvement $18,541 3-months prior vs $2,742 3-months after PaC involvemen, driven by lower part A and part B costs (p=0.001) Conclusions: ECOG PS monitoring of pts with mCa by PCPs was very successful, easy to perform and implement in a PrC. Poor PS is common in this medicare advantage population. PaC involvement in pts with poor ECOG-PS was associated with lower admission rates at the end of life, and significantly lower total medical costs. [Table: see text]

Grounding co-writing: An analysis of the theoretical basis of a new approach in mental health care.

This contribution aims to highlight the theoretical and epistemological premises of the co-writing experience, a practice where a clinician and a patient are mutually engaged in jointly or collaboratively writing a narrative related to the patient's experience. Unlike a typical set of therapeutic techniques, co-writing is based on sharing perspectives and meanings about the experience of crisis, recovery, and the therapeutic process. The paper identifies and briefly describes four non-clinical epistemological paradigms on which it is grounded: ethnography, values-based practice, narrative care, and phenomenology. Although they differ in several ways, at the same time, they seem to share some common features that the paper investigates and comments. For clinicians, nurses, researchers and Mental Health Service managers, attention to the users and to the improvement of their active roles represents not only a strategy for the empowerment of results, but also the access door to a different perspective which relies on a renewed conceptualization of the mental disease nature that may lead to overcoming the epistemic asymmetry between the 'expert' and the 'other' in favor of intersubjective dialogue.

Price Transparency in Neurosurgery: Challenges and Opportunities in the Online Publishing of Treatment Prices to Enable Cost-Conscious and Value-Based Practice

There is a paucity of evidence describing the price information that is publicly available to patients wishing to undergo neurosurgical procedures. We sought to investigate the public availability and usefulness of price estimates for non-emergent, elective neurosurgical interventions. Google was used to search for price information related to 15 procedures in 8 major U.S. health care markets. We recorded price information that was published for each procedure and took note of whether itemized prices, potential discounts, and cross-provider price comparisons were available. Online searches yielded 2356 websites, of which 228 (9.7%) offered geographically relevant price information for neurosurgical procedures. Although accounting for only 16.4% of total search results, price transparency websites provided most treatment price estimates (74.1% of all estimates), followed by clinical sites (19.3%), and other related sites (5.3%). The number of websites providing price information varied significantly by city and procedure. websites rarely divulged data sources, specified how prices were estimated, indicated how frequently price estimates were updated, offered itemized breakdowns of prices, or indicated whether price estimates encompassed the full spectrum of possible health care charges. Under 10% of websites queried yield geographically relevant price information for non-emergent neurosurgical imaging and operative procedures. Even when this information is publicly available, its usefulness to patients may be limited by various factors, including obscure data sources and methods, as well as sparse information on discounts and bundled price estimates. Inconsistent availability and clarity of price information likely impede patients' ability to discern expected costs of treatment and engage in cost-conscious, value-based neurosurgical decision-making.

Informal Education Pedagogy Transcendence from the ‘Academy’ to Society in the Current and Post COVID Environment

The purpose of this paper is to consider the following two notions; (1) that the use of ‘informal education pedagogies’ within teaching and learning in the ‘academy’ can both support the learning process within the ‘classroom’ but also transcend to society via students; and (2) that synergies exist between informal education and social pedagogical concepts. The discussions are situated from the perspective of an experienced practitioner and academic who is currently teaching youth related degree courses within a Higher Education Institution. This experiential learning has informed knowledge acquisition, understanding and skills application from professional practice to the teaching environment. An experiential learning perspective will be the primary method adopted; the value of this paper lies in its potential to re-affirm that degree courses which embed a ‘practice the practice’ approach in their teaching methodology support the embedding of core values of the said discipline. The paper argues that the ethically value-based principles and practice of informal education pedagogy, and social pedagogy, are relevant for the current and post COVID-19 pandemic environment.

Orthopaedic Business is the Focus of 3.4% of Articles in Top General Orthopaedic Journals.

Objectives: The purpose of this study is to compare the proportion of business articles in top general orthopaedic journals. Design: Review. Intervention: Categorize all articles from general orthopaedic journals with top four H-Index. Main outcome measurement: Articles categorized as payer analysis (PA), cost analysis (CA), value-based practice (VBP), Management and human resources (HR), practice efficiency (PE) and the business of scholarship (SC). Results and conclusions: JBJS, B&JJ, CORR, and JAAOS were identified as top orthopaedic journals. All had some level of business scholarship with an average of 3.4% of articles dedicated to business, ranging from 2 to 7%. Of business-related articles 27% of articles were cost analysis, 25% focused on practice efficiency, 22% on Value based practices, 16% payer analysis, 7% business of scholarship and 4% on human resources. The lack of scholarship regarding human resources represents a significant opportunity for improvement as a profession. Level of Evidence: IV; Review Keywords: Business, management, human resources, cost, value, efficiency. (J Ortho Business 2021; 2:9-12)

Social justice in counseling psychology practice: Actualizing the ethics of compassion

This article articulates how compassion can be integrated into counseling psychology practice to augment the commitment to social justice. Drawing on a humanistic–existential paradigm that asserts the primacy of ethics, a multilayered understanding of compassion is explored in its implication for practitioners. First, as acknowledgment of the other’s suffering, compassion means being aware of the relational dynamics that extends from the therapist–client dyad to include the wider communities to which they belong. Second, as appreciation for suffering as an existential given, compassion expresses connectedness through the shared experience of otherness while revealing the inherent potential toward growth in clients. Third, as access to the suffering other, compassion exposes the societal power dynamics that threaten the therapeutic relationship. Fourth, as acceptance of the response to the suffering other, compassion requires to embrace the intrapersonal and interpersonal experience evoked in meeting clients. Fifth, as alleviation of the other’s suffering, compassion becomes the expression of a value-based practice that can drive the shift that sees psychotherapy as an interpersonal process based on connectedness to foster healing. Therefore, compassion is put forward as the foundation of counseling psychology ethics of social justice.

Values-based practice: how can history taking help psychiatrists explore the values involved in clinical decision-making?

SUMMARYValues-based practice (VBP) is a framework of clinical theory and skills to facilitate a good process whereby the (often conflicting) values involved in clinical decision-making can be recognised and balanced productively. Many of these values come from the personal histories of the patient and of the clinician, and the traditions and history of psychiatry. New developments in science lead to increasing choice and increasing complexity of values. Therefore, psychiatrists will need more skills in this area, as reflected by the inclusion of VBP in the Royal College of Psychiatrists’ training curricula. This article describes some tools for understanding and navigating this value diversity in applying science to clinical practice during history taking.

Spinal subdural hemorrhage in abusive head trauma: a pictorial review.

A growing body of evidence links abusive head trauma (AHT) to patterns of direct and indirect spinal injuries, such as spinal subdural hemorrhage (SDH). Identification of evidence of spinal injury such as spinal SDH plays a crucial role in the diagnosis and subsequent management of the index child with AHT and his or her siblings. In a value-based practice of medicine, it can be argued that adding spine imaging to identify spinal SDH in the workup of AHT adds value to both the short- and long-term management of the patient. This pictorial review describes the normal appearance of spinal SDH and challenges of identifying spinal SDH, and it explores the mechanism of spinal SDH development in AHT.

"It's real, it's much more real": An exploration of Values-Based Reflective Practice© as a reflective tool

"It's real, it's much more real": An exploration of Values-Based Reflective Practice© as a reflective tool

Opportunistic Screening at Abdominal CT: Use of Automated Body Composition Biomarkers for Added Cardiometabolic Value.

Abdominal CT is a frequently performed imaging examination for a wide variety of clinical indications. In addition to the immediate reason for scanning, each CT examination contains robust additional data on body composition that generally go unused in routine clinical practice. There is now growing interest in harnessing this additional information. Prime examples of cardiometabolic information include measurement of bone mineral density for osteoporosis screening, quantification of aortic calcium for assessment of cardiovascular risk, quantification of visceral fat for evaluation of metabolic syndrome, assessment of muscle bulk and density for diagnosis of sarcopenia, and quantification of liver fat for assessment of hepatic steatosis. All of these relevant biometric measures can now be fully automated through the use of artificial intelligence algorithms, which provide rapid and objective assessment and allow large-scale population-based screening. Initial investigations into these measures of body composition have demonstrated promising performance for prediction of future adverse events that matches or exceeds the best available clinical prediction models, particularly when these CT-based measures are used in combination. In this review, the concept of CT-based opportunistic screening is discussed, and an overview of the various automated biomarkers that can be derived from essentially all abdominal CT examinations is provided, drawing heavily on the authors' experience. As radiology transitions from a volume-based to a value-based practice, opportunistic screening represents a promising example of adding value to services that are already provided. If the potentially high added value of these objective CT-based automated measures is ultimately confirmed in subsequent investigations, this opportunistic screening approach could be considered for intentional CT-based screening. ©RSNA, 2021.

Teaching Mental Health and Well-Being Online in a Crisis: Fostering Love and Self-compassion in Clinical Social Work Education.

The coronavirus (COVID-19) pandemic has shifted clinical social work (CSW) and mental health education in Australia, and indeed throughout much of the globe, onto online delivery. The disruption caused by COVID-19 presents unexpected challenges in fostering the development of skill sets among social work educators in partnership with students. This article is a reflexive collaborative autoethnography written by four educators of different international and cultural backgrounds at a regional university in Queensland. Our university has experienced a shift from primarily a face-to-face delivery to online delivery due to social distancing. This article is grounded in an ethic of love, a values-based relationship-oriented practice promoting care, collaborative dialogue and solidarity between people, using self-compassion and reflexivity. We explore how COVID-19 has forced the authors to alter their teaching practice, cope with uncertainties, and respond with loving kindness to the shifting needs of students. We draw upon our experiences as educators of diverse cultural, linguistic, gender, and sexualities from Australia, the United States, the United Kingdom, and Nigeria and reflect upon how we have simultaneously turned inward and outward through technology. We draw upon person-centered, narrative, trauma informed and anti-oppressive clinical and educational approaches when exploring self-compassion and loving approaches with the students. We discuss the need for self-compassion and love of others as we respond to the current crisis by modeling self-compassion and love for CSW students who are experiencing crises, including loss of employment, separation from family overseas and interstate, isolation from colleagues and loved ones, and healthcare issues.

Curing Psychiatry's Schizophrenia: A Commentary in Values-Based PHD Mental Health Practice

Curing Psychiatry's SchizophreniaA Commentary in Values-Based PHD Mental Health Practice K.W.M. (Bill) Fulford (bio) From the perspective of values-based practice (VBP), there is much of interest in Lorenzo Gilardi and Giovanni Stanghellini's "I am a Schizophrenic." Their dialogue exhibits many of the key elements of VBP, it exemplifies the particular challenges presented by VBP in mental health, it illustrates the power of phenomenology in meeting these challenges, and it points by extension to an insight into contemporary psychiatry's professional identity as a medical profession. VBP is a resource for working with values—with what matters or is important to those concerned—in healthcare (Fulford, Peile, & Carroll, 2012). Avoiding preset answers, it offers instead a process that supports those concerned in a given situation finding answers for themselves. Developed first in mental health as a practical offshoot of analytic philosophy and psychiatry (Fulford, 1989; Fulford & van Staden, 2013), VBP is now being extended to other areas of health and social care: the Director of the VBP Centre in Oxford is the vascular surgeon and Oxford's Tutor for Surgery, Ashok Handa (Handa et al., 2016; see also: www.//valuesbasedpractice.org). That "I am a schizophrenic" should be transparently values-based is unsurprising given Giovanni Stanghellini's important contributions to the field (more on this below). Evident in the dialogue between LG and GS are many of the key skills of VBP (notably, awareness of values and listening skills); the approach is dialogic (it is a conversation not a medical monologue); and the dialogue is patient-values-centered (it focuses on what matters or is important to LG). Evident, too, is the importance of narrative. Relegated to the bottom of the evidence hierarchy, narrative comes at the top of the corresponding values hierarchy (Fulford, 2020): and the LG/GS dialogue convincingly illustrates why this should be so. Then again, coming to VBP in mental health, the LG/GS dialogue is co-productive (it is a dialogue between equals); it is positive (it is concerned as much with LG's strengths as with his needs and difficulties (National Institute for Mental Health in England and the Care Services Improvement Partnership, 2008); and it is recovery oriented (it is aimed not at symptom control but rather at rebuilding a good quality of life as defined by what matters to LG as an individual (Slade, 2009). Importantly, there is nothing in the LG/GS dialogue that from the perspective of VBP is peculiar to psychiatry. True, it would be surprising, even [End Page 15] in Oxford, if Schopenhauer, Blankenburg and Nietzsche were all to come up within minutes of each other in a values-based consultation in Ashok Handa's aortic surgery outpatient clinic. But this is a difference only of content. In a consultation about aortic surgery the material values (the things that matter or are important) involve such (conceptually) straightforward issues as side effects (including death), length of stay in hospital, and the likelihood of relapse. The corresponding values in the LG/GS dialogue, by contrast, involve the (conceptually) far-from-straightforward nature of personal identity. Hence, then, the resort in the LG/GS dialogue to Schopenhauer, Blankenburg, and Nietzsche. Hence, too, the more challenging nature of VBP as a whole in mental health as compared with areas of bodily medicine such as surgery. Which is where Giovanni Stanghellini has been early in the field in adding to the originating analytic philosophical resources of VBP, the resources of phenomenology. There is, of course, a long tradition of phenomenological research in psychiatry (Stanghellini & Fuchs, 2013). There have been other initiatives, too, in phenomenological VBP (e.g., in addictive disorders; Messas and Soares, forthcoming, 2020). Stanghellini has given us what he calls a "PHD" model of therapy (Stanghellini, 2019). The LG/GS dialogue nicely illustrates how the PHD model combines the life-world insights of phenomenology with the heuristic methods of the hermeneutic circle in a dialogical form of person-centered phenomenological-dynamic psychotherapy. LG, it is true, is a particularly well-read and philosophically insightful patient. This is perhaps why as their dialogue nicely illustrates, GS and LG speak the same language. But this, again...

A values-based phenomenology for substance use disorder: a new approach for clinical decision-making

Abstract Phenomenological psychopathology has been defined as a human science that is concerned with the object on which clinical psychology and psychiatry act. How psychopathological experiences are understood is an important factor determining decision-making in clinical care. An accurate understanding of psychopathology is fundamental to the effectiveness of mental health treatments. This is even more important in a field such as substance use disorders in which social and cultural values influence both diagnosis and decision-making. In this article, we offer a contribution to clinical decision-making in substance use disorders by suggesting the association of Phenomenological Psychopathology and Values-Based Practice, constituting a Values-based Phenomenology We present a fictitious clinical case (to preserve confidentiality), illustrating a three-step practical application of Values-based Phenomenology. We conclude that although still a nascent discipline, Values-based Phenomenology offers a promising approach to reducing the gap between services and patients’ needs in clinical decision-making, and thus to improving clinical care in substance use disorders.

A non-modern vision: facts and values in psychotherapy

Evidence-based practice in psychology is the prevailing regulatory principle for psychotherapy practice. This paper criticises the notion of facts and values in evidence-based practice in psychology and related concepts. More particularly, it aims at showing that values-based practice follows a modern scheme contrasting facts and values sharply. Person-centred medicine is suggested as a more viable option. Person-centred medicine follows a non-modern scheme in which facts and values are integrated. This move, it is argued, will lead to a more humanistic conception of the patient and psychotherapy.

Integrating Advanced Practice Providers into value based care strategies: One organization's journey to achieve success through interprofessional collaboration

Abstract As the landscape of healthcare is shifting from volume-based to value-based practice, organizations are challenged to develop models that promote such changes with current resources while enriching the patient experience. A critical component to be successful, is utilizing an interprofessional team approach. An urban academic pediatric hospital developed such strategies by enhancing the use of Advanced Practice Providers (APPs) to optimize care. Through a series of tactics beginning with the strategic plan, results included an increase in volume, APP productivity, and enhanced satisfaction scores for both providers/patients, and an increase in access to pediatric specialty care.

Groundwork for a metaphysic of person-centred care: a contribution from Ordinary Language Philosophy

This article explores the meaning of person-centred care using an approach based on the ordinary language philosophy of J.L. Austin and others of the mid-twentieth Century ‘Oxford School’. Section I outlines the essential feature of ordinary language philosophy as a shift of attention from definition to use: ordinary language philosophy explores the meanings of terms (and their inherent conceptual challenges) not by the traditional philosophical approach of ever-more-careful definition but by exploring how the terms in question are actually used in everyday (i.e. unreflective) contexts. Section II explores the conceptual challenges presented by person-centred care by applying three particular components of ordinary language philosophy (philosophical field work, outputs as more complete views, and methodological teamwork) to two exemplar papers. Section III describes how the groundwork provided by ordinary language philosophy of the kind exemplified by Section II has been built on successfully in one particular form of person-centred care, namely the person- values -centred care of values-based practice. The chapter concludes with some of the limitations and challenges presented by an ordinary language philosophy of person-centred care. Of particular concern in the light of Isaiah Berlin’s work on the ‘challenge of pluralism’ is the inherent and irreducible pluralism of person-centred care.

Hall of Mirrors: Toward an Open Society of Mental Health Stakeholders in Safeguarding against Psychiatric Abuse

This article explores the role of an international open society of mental health stakeholders in raising awareness of values and thereby reducing the vulnerability of psychiatry to abuse. There is evidence that hidden values play a key role in rendering psychiatry vulnerable to being used abusively for purposes of social or political control. Recent work in values-based practice aimed at raising awareness of values between people of different ethnic origins has shown the importance of what we call “values auto-blindness” – a lack of awareness of one’s own values as a key part of our background “life-world” – in driving differential rates of involuntary psychiatric treatment between ethnic groups. It is argued that the vulnerability of psychiatry to abuse stems from values auto-blindness operating on the judgments of rationality implicit in psychiatric diagnostic concepts. Acting like a “hall of mirrors,” an international open society of mental health stakeholders would counter the effects of values auto-blindness through enhanced mutual understanding of the values embedded in our respective life-worlds across and between the diverse perspectives of its constituents. The article concludes by noting that a model for the required open society is available in the contemporary interdisciplinary field of philosophy and psychiatry.

Debate: COVID crisis, natural capital and clinical care - 'building back better' for a new values-based CAMHS.

The COVID-19 pandemic has meant upheaval for child and adolescent mental health services and for children, young people and their families. We look at this disruption through the lens of values-based practice. We also briefly examine the concept of natural capital and the opportunity for 'Building Back Better' post-COVID. We suggest that as well as losses, there are also opportunities to rethink and reshape our practices to make them more value-based.

From selection to registration, and beyond: Supporting the student diagnostic radiographer in becoming a compassionate professional.

The National Health Service (NHS) Constitution aims to safeguard the underpinning principles and values of the NHS. Whilst employers are obligated to recruit staff whose values and behaviours align with those of the Constitution, Higher Education Institutions (HEIs) are also expected to select students who demonstrate an understanding of those values and behaviours and potential to use them with their working practices. From the point of selection, HEIs assume a pivotal role in promoting and embedding those values and behaviours into curricula, and thus supporting individuals in the transition from student to professional.The purpose of this paper is to discuss how values-based practice has been embedded in undergraduate radiography education at our HEI. It describes how the HEI utilises values-based recruitment and selection processes, and explores the strategies employed to develop that foundation prior to entering practice placement. Key issues will be discussed including the importance of acknowledging and valuing the early experiences of students prior to being socialised into the established culture of the diagnostic imaging departmentThe role of the lecturer in supporting the transition from student to compassionate professional cannot be underestimated. This is multi-faceted and acting as a professional role model to students is an essential part of this whilst helping students to develop their own professional development throughout the course.