Medicine and Health Sciences Commons^™

Are We Providing Patient-Centered Care? Preferences About Paracentesis And Thoracentesis Procedures, Jeffrey H. Barsuk, Sarah E. Kozmic, Jordan Scher, Joe Feinglass, Aimee Hoyer, Diane B. Wayne

Patient Experience Journal

Procedures performed at the bedside are as safe and less expensive than Interventional Radiology (IR) procedures. Patient preferences regarding location are rarely taken into account. Therefore, in this study we compared patient satisfaction with bedside and IR paracentesis and thoracentesis procedures, and identified reasons for patient location preferences. We performed a cross-sectional survey of medical inpatients undergoing paracentesis or thoracentesis procedures at a tertiary care academic medical center. The survey had eight domains: overall experience, pain control, expertise, courtesy, bedside manner of the physician, time required, explanation of risks/benefits, comfort and privacy. Patients were also asked about their preference for …

Using A Data-Driven Organizational Improvement Model To Engage An Interdisciplinary Team In Transforming A Public Women’S Health Clinic, Kenneth J. Feldman, Molly Lopez, Morris Gagliardi

Patient Experience Journal

Gouverneur Health is the largest diagnostic and treatment center in New York State, and part of the New York City Health and Hospitals Corporation (HHC), a public benefit corporation with $6.7 billion in annual revenues. HHC is the largest municipal healthcare system in the United States serving 1.4 million patients, including more than 475,000 uninsured city residents.[1] Within Gouverneur, the Women’s Health department is committed to providing high quality services that improve patients' health and wellbeing, yet patient experience, flow, clinic access and education are in need of process improvements. To enhance patient experience and identify strategies replicable for other …

Feasibility Of Using Emergency Department Patient Experience Surveys As A Proxy For Equity Of Care, Helen Chiu, Nadia Batara, Robert Stenstrom, Lianne Carley, Catherine Jones, Lena Cuthbertson, Eric Grafstein

Patient Experience Journal

Collecting and examining equity data can help inform quality improvement initiatives but is a relatively new practice in health care. The overall goal of this study was to assess different methods of administering patient experience surveys as a feasible starting point in measuring equity in an urban Emergency Department (ED) that serves a diverse patient population. Socio-demographic characteristics of patients visiting an ED were compared with those of patients who responded to provincial patient experience surveys routinely administered by mail. Patient experience survey data were collected over an 11-week period in an urban ED using different survey administration methods (face-to-face …

The Relationships Between Hcahps Communication And Discharge Satisfaction Items And Hospital Readmissions, Fadi Hachem, Jeff Canar, Francis Fullam Ma, Andrew S. Gallan Phd, Samuel Hohmann, Catherine Johnson

Patient Experience Journal

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become a key metric used by organizations and patients to evaluate patient experience. Readmissions also continue to be a metric used to evaluate performance because of the added cost to both healthcare systems and patients. Both measures are also seen in programs such as Value Based Purchasing that have an effect on hospital reimbursements. Previous studies have demonstrated a relationship between patient perceptions and quality of care, and have found patients to be reliable evaluators of their care. While good communication and positive provider relationships have been related …

Evaluation Of An Advisory Committee As A Model For Patient Engagement, Cynthia Kendell, Robin Urquhart, Jill Petrella, Sarah Macdonald, Meg Mccallum

Patient Experience Journal

Patient engagement (PE) is not well defined and little guidance is available to those attempting to employ PE in decision-making relevant to health system improvement. After completing a 2-year PE project, overseen by an Advisory Committee, our objectives were: 1) to evaluate how effectively the project team engaged the Advisory Committee, 2) to examine how Advisory Committee members perceived PE and their role in PE, and 3) to identify barriers and facilitators to PE in order to improve future efforts. Five members of the Advisory Committee completed semi-structured interviews post-project about their experiences. Thematic analysis identified four themes: the approach, …

Improving The Patient Experience Through Nurse Leader Rounds, Judy C. Morton, Jodi Brekhus, Megan Reynolds, Anna Kay Dykes

Patient Experience Journal

While providing exceptional care experiences to patients is a priority for many organizations, creating and sustaining measureable success in this area remains a challenge for many. This article examines the impact of implementing nurse leader rounds on patient perception of care in the hospitals and emergency departments of a large healthcare system. Nurse leader rounds were implemented as a system-wide improvement practice at Providence Health & Services in 2012. Analysis of Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results indicates that implementation of nurse leader rounds is associated with statistically significant improvement in patient …

Creating And Sustaining A Culture Of Accountability For Patient Experience, Denise M. Kennedy Mba, Roshanak Didehban Mhs, Fache, John P. Fasolino Md

Patient Experience Journal

Improving the quality of the patient experience has become an imperative for healthcare organizations. Value-based payment models include patient perception data, and a negative experience can impact an organization’s finances. Sustainable improvement requires more than quick-fix cosmetic enhancements, ‘flavor-of-the-month’ service trainings, or bonuses for front-line staff. Organizations must actually improve the patient experience. Doing so requires a culture of accountability and a systematic framework for collecting and acting on patient perception data.

This article revisits Mayo Clinic Arizona's (MCA) "7-prong" model for improving service quality: (1) multiple data sources to drive improvement; (2) accountability; (3) service consultation and improvement tools; …

Enhancing Patient Experience By Training Local Trainers In Fundamental Communication Skills, Calvin L. Chou, Laura Cooley, Ellen Pearlman, Maysel Kemp White

Patient Experience Journal

Medical centers have a vested interest in improving patient experience through enhancing communication skills. The American Academy on Communication in Healthcare has helped institutions across the country establish internal expertise through delivering train-the-trainer programs. The phases of the program include preparing for implementation of the program, having program participants undergo a fundamental communication skills workshop and then understanding the theoretical and practical rationales underlying the workshop, setting up practice sessions for participants to achieve mastery, and ensuring long-term viability of a communication skills improvement initiative. Outcomes for participants include increased self-assessed personal communication skill, optimism about rolling out a communication …

Beyond Credentialing In Physician Selection: Application Of An Instrument That Measures Behavioral Aptitude, Edgar Staren Md, Phd, Mba, Susan Hirt Ph.D., Doug Rath M.A.

Patient Experience Journal

This article explores the idea that the assessment of candidates for the role of physician caregiver can be enhanced by evaluating their inter-personal and behavioral aptitude as well as their clinical skills. The objective of this work was to determine whether results of a structured interview correlate to performance ratings for physicians. Two data sets were collected: a structured aptitude assessment for physicians (the Physician Interview) and job performance data for physicians. Analysis of performance data allowed categorization of the physicians into three groups: top performers, contrast performers, and neither. The two data sets were then analyzed to assess the …

Patient Experience Of Care In A Student-Faculty Collaborative Practice, Rebecca A. Berman, Scott Elman, Pratyaksh Kumar Srivastava, Janine Knudsen, Laura Huppert, Kyle Dempsey, Michael Barnett, Camille Powe, Karen Donelan

Patient Experience Journal

Student Run Clinics (SRCs) are a popular means of caring for the underserved while providing valuable medical education opportunities. Reports of patient experience surveys are rare in this setting. This is troublesome because it is possible that underserved patients, who are more likely to receive care at SRCs, are not receiving the same level of care as at more traditional medical practices. The purpose of this research was to measure patient experience in a student-led medical clinic. The method included the use of patient experience surveys, which were self-administered pre-visit and self- and interviewer administered post-visit. The key results, 100% …

Hindsight Is 20/20: Lessons Learned After Implementing Experience Based Design, Kate Bak, Laura Macdougall, Esther Green, Lesley Moody, Genevieve Obarski, Lori Hale, Susan Boyko, Deborah Devitt

Patient Experience Journal

Experience Based Design (EBD) uses patient and staff experiences to identify quality improvement opportunities in healthcare settings. An EBD Collaborative was established to share successes and challenges related to the EBD projects. This paper summarizes the various lessons learned. A document analysis was conducted that examined meeting minutes and audio recordings, email communications, newsletters, project updates, project spotlights and evaluation surveys and interviews. A total of ten key themes were identified. While EBD teams encountered challenges, overall the experience led to successful quality improvement initiatives. In particular, staff gained new insights from the patients’ perspective, which enhanced their understanding of …

The Patient Experience Movement Moment, William Lehrman Phd, Geoffrey Silvera Mha, Jason A. Wolf Phd

Patient Experience Journal

For years, the patient experience movement has continued to gain momentum. From a novel concept, there is an emerging consensus that the patient experience is a fundamental aspect of provider quality; one that complements established clinical process and outcome measures but is neither subsumed nor secondary to them. An increasing volume of research as encouraged by publications such as Patient Experience Journal show this to be true. As the expectation of a high-quality patient experience becomes the norm, these developments have brought us to what we call the patient experience movement moment and there is little doubt that the patient …

To Serve Patients Is Our Greatest Privilege, David T. Feinberg Md, Mba

Patient Experience Journal

In his guest editorial, Dr. David Feinberg of UCLA Health System reminds us of the power of patient voice and the lessons we should be open to learning from those we serve every day. He offers, "It is a blessing for us to work in an environment where we have the opportunity every day to touch someone’s life so deeply. We must never lose sight of that. It is our responsibility to not just treat our patients, but also to embrace them."

A Gathering Place For Patient Experience Research: The Power Of Community, Jason A. Wolf Phd

Patient Experience Journal

In introducing Issue 2, we explore the power of community and its implications in shaping not only the purpose and intent of Patient Experience Journal, but of the patient experience movement itself. Community defined in this moment is simple, yet significant, the key being unity around common interest and its focus on ownership and participation. The idea of community bears great weight and has provided strong guidance and purpose for the work of experience excellence. It supports the goal of elevating the conversation, helps align the voices engaged and provides the space for listening, learning and impact.

Experience Framework …

Improving Functional Independence With Rehabilitation Following A Metastatic Melanoma Brain Tumor Resection: A Case Report, Benjamin Sherr

Case Report Posters

History: A 67 year-old male with a one year history of melanoma complained of headaches 1-2 weeks prior to admission to an acute care hospital with left sided hemiplegia and dysarthria. A head CT scan revealed an intracerebral hematoma and a lesion suspicious for metastasis within the right parietal lobe. A right parietal craniotomy, evacuation of the hematoma and resection of the brain tumor were performed and the pathology revealed metastatic melanoma. Discussion: The patient received 18, 60-75 minute physical therapy sessions over a span of 21 days while in the inpatient rehabilitation unit. This case study utilized many essential …

Outpatient Physical Therapy Management Of A Patient Three Months Following Left Shoulder Arthroscopic Repair Of A Type-Ii Slap Lesion: A Case Report, Charles Dowd

Case Report Posters

Background: Research demonstrates a drastic increase in the prevalence of type-II superior labral anterior-posterior (SLAP) lesion repairs, and its surgical correction has become the favored method of treatment, because of its ability to effectively improve quality of life (QOL). A type-II SLAP lesion consists of fraying and degenerative changes to the superior labrum, in an anterior to posterior direction, with the biceps tendon detached from the glenoid. Purpose: Document the examination, evaluation, and plan of care (POC) concerning a patient that was referred to physical therapy (PT) three months following the surgical correction of a type-II SLAP lesion.

Outpatient Physical Therapy Following Surgical Debridement Of Osteochondritis Dissecans Of The Talar Dome: A Case Report, Angela Serrani

Case Report Posters

Background: Osteochondritis Dissecans (OCD): Alteration of subchondral bone with disruption of the adjacent articular cartilage; cause unknown, hypotheses include repetitive trauma and or non-traumatic disruption of subchondral blood supply; suspected chondral injury with up to 50% of ankle instability episodes. Treatment Options: Goals: relieve symptoms and improve function; non-surgical: rest, immobilization, NSAIDS; surgical: excision of lesion, excision with cutterage and/or microfracturing, filling the defect with bone graft, antegrade transmelleolar drilling, retrograde drilling, fixation, osteochondral transplantation, and autologous chondrocyte implantation. Purpose: To describe physical therapy treatment and outcomes for a patient following surgical debridement of OCD of the talar dome.

Physical Therapy Management With Emphasis On Quadriceps Strength Training For Chronic Patellar Dislocations In A Female Adolescent With Kabuki Syndrome: A Case Report, Liesel Jay

Case Report Posters

Background: Kabuki Syndrome (KS) has a current estimated prevalence at 1 in 32,000. KS is a rare, but highly recognizable genetic disorder manifested in the craniofacial, skeletal, neurological, and cardiovascular systems/regions of the body. Patellar dislocations are common in children with KS due to the presence of hypotonia causing muscle imbalances and joint laxity. Most commonly, treatment of patellar islocations are done conservatively through exercise. Surgical interventions (lateral release, medical imbrication, medial patellofemoral ligament reconstruction, or bone realignment) are considered with continued dislocations. Purpose: Physical therapy management approach with a focus on addressing chronic patellar dislocations through quadriceps strengthening in …

The Use Of Electrical Stimulation And Cryotherapy In Pain Reduction For A Patient Following An Arthroscopic Partial Meniscectomy: A Case Report, Miranda Carlson

Case Report Posters

Background: An arthroscopic partial meniscectomy is a common procedure that consists of removing some of the meniscus from the tibio-femoral joint. It is a minimally invasive surgery. Following the procedure, physical therapy is used to improve function. In many cases, some level of pain management is utilized which may include Transcutaneous Electrical Nerve Stimulation (TENS) and cryotherapy. TENS has been shown to be more effective than pain medication following arthroscopic knee surgery and aid in faster regains of strength and range of motion. Cryotherapy for pain management has been shown to have a significant effect on the level of pain, …

Long-Term Survival After Cabg In Diabetics With Aggressive Risk Factor Management, Kendal Endicott, Conor Hynes, Dominic A. Emerson, Peter F. Kokkinos, Michael D. Greenberg, Gregory D. Trachiotis

Medicine Faculty Publications

Objectives: Diabetes is a well-established risk factor for cardiovascular disease, and diabetics have a threefold increase in risk of death from cardiovascular disease compared to non-diabetics. Following coronary artery bypass grafting, tight glycemic control improves short-term outcomes, however limited data exist for long-term outcomes. Here we examine these outcomes in diabetics using aggressive risk factor management.

Methods: A retrospective review of all patients under-going coronary artery bypass between 1991 and 2000 at a single Veterans Affairs Medical Center was undertaken. 973 patients were included, 313 with diabetes and 660 without. Strict glucose control was maintained for all patients. Additional risk …

The Long Non-Coding Rna Pcat-1 Promotes Prostate Cancer Cell Proliferation Through Cmyc., John R. Prensner, Wei Chen, Sumin Han, Matthew K. Iyer, Qi Cao, Vishal Kothari, Joseph R. Evans, Karen E. Knudsen, Michelle T. Paulsen, Mats Ljungman, Theodore S. Lawrence, Arul M. Chinnaiyan, Felix Y. Feng

Department of Cancer Biology Faculty Papers

Long non-coding RNAs (lncRNAs) represent an emerging layer of cancer biology, contributing to tumor proliferation, invasion, and metastasis. Here, we describe a role for the oncogenic lncRNA PCAT-1 in prostate cancer proliferation through cMyc. We find that PCAT-1-mediated proliferation is dependent on cMyc protein stabilization, and using expression profiling, we observed that cMyc is required for a subset of PCAT-1-induced expression changes. The PCAT-1-cMyc relationship is mediated through the post-transcriptional activity of the MYC 3' untranslated region, and we characterize a role for PCAT-1 in the disruption of MYC-targeting microRNAs. To further elucidate a role for post-transcriptional regulation, we demonstrate …

The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays

Health Management and Policy Presentations

We estimate the dynamics and interactions of governmental spending on Medicaid and other public health services in all 50 states over a 15 year period. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.

Sustained Vigilance, Errors, And Job Satisfaction In A Population Of Critical Care And Emergency Department Nurses, Skip G. Morelock

Nursing Theses and Dissertations

Despite the continuing efforts of health care organizations to provide a culture of safety, an unacceptable number of medication incidents and hospital errors continue to occur. This study focuses on these events as they relate to job satisfaction in the context of sustained vigilance required of acute care nurses. A constellation of variables contribute to errors including fatigue, stress, overload, protocol satisfaction, and practice risk. The study includes an intense examination of the physiological and psychological effects of night shift work. The results reflect a correlation between fatigue and errors with a less robust, though still statistically significant, association with …

Students’ Attitudes And Perceptions Toward Interprofessional Education, Rabia Foreman, Lacey Harris, Kathryn Mcguire, Kerry Proctor-Williams, Katie Baker

ETSU Faculty Works

Three scales were administered to measure attitudes of graduate students in health professions prior to their participation in an interprofessional education (IPE) pilot program. Overall, results indicated that students’ attitudes toward IPE were generally positive, but there is room for improvement. Additionally, medical students’ attitudes differed from the other disciplines.

A Proposed Holistic Model Of Assessment For Children With Cleft Palate Within The Icf-Cy Framework, Rabia Foreman, Jamesa Ewing, Olivia Hawley, Mariana De Cassia Macedo, Naiara Rodrigues Carlota Do Nascimento, Brenda Louw, Luciana Maximino

ETSU Faculty Works

The purpose of this project is to describe a proposed model for the assessment of children with cleft palate within the framework of the ICF-CY (WHO, 2007). Suggestions for clinical application and cleft palate curricula are made, and future research needs are identified.

Parental Perspective: Toddlers With Clefts Using Touch Screen Technology, Cortney Vineyard, Alexandra Coup, Chelsey Hazelett, Rachel Janes, Brenda Louw

ETSU Faculty Works

This investigation assessed the parental perspectives of parents of toddlers with cleft lip and palate and their use of touchscreen technology. Findings will highlight parental perspectives on touchscreen technology in early intervention with their toddler.

Neurodevelopmental Outcomes For Infants With Neonatal Abstinence Syndrome: Implications For Speech-Language Pathologists And Audiologists, Kerry Proctor-Williams

ETSU Faculty Works

The causes and neurodevelopmental outcomes of children exposed to drugs and/or alcohol prenatally are presented. The incidence of this population is rising rapidly and appearing in increasing numbers on the caseloads of speech-language pathologists. Topics include prevalence, common drugs, Neonatal Abstinence Syndrome, longer-term neurodevelopmental outcomes, and treatment challenges.

Transformational Leadership In Nursing: A Pilot Nurse Leader Development Program, Audria G. Denker

Graduate Theses, Dissertations, and Capstones

Current research reveals that staff nurses are routinely placed into front-line leadership roles with little formal preparation. The purpose of this project was the development, implementation, and evaluation of a pilot nurse leader development program for nurse leaders at a small community hospital located in Clarksville, Indiana. This study consisted of a quasi-experimental design, with the intervention consisting of a leadership course delivered to a convenience sample of nurses in managerial positions. Leadership attributes was quantified, both pre/post interventions, through the administration of the Leadership Practices Inventory (LPI), a Likert-scaled survey. The LPI was administered to the nurse leaders, their …

Hormone-Induced Calcium Oscillations Depend On Cross-Coupling With Inositol 1,4,5-Trisphosphate Oscillations., Lawrence D Gaspers, Paula J Bartlett, Antonio Politi, Paul Burnett, Walson Metzger, Jane Johnston, Suresh K Joseph, Thomas Höfer, Andrew P Thomas

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Receptor-mediated oscillations in cytosolic Ca(2+) concentration ([Ca(2+)]i) could originate either directly from an autonomous Ca(2+) feedback oscillator at the inositol 1,4,5-trisphosphate (IP3) receptor or as a secondary consequence of IP3 oscillations driven by Ca(2+) feedback on IP3 metabolism. It is challenging to discriminate these alternatives, because IP3 fluctuations could drive Ca(2+) oscillations or could just be a secondary response to the [Ca(2+)]i spikes. To investigate this problem, we constructed a recombinant IP3 buffer using type-I IP3 receptor ligand-binding domain fused to GFP (GFP-LBD), which buffers IP3 in the physiological range. This IP3 buffer slows hormone-induced [IP3] dynamics without changing steady-state …

Wordless Intervention For Epilepsy In Learning Disabilities (Wield): Study Protocol For A Randomized Controlled Feasibility Trial, Marie-Anne Durand, Bob Gates, Georgina Parkes, Asif Zia

Dartmouth Scholarship

Epilepsy is the most common neurological problem that affects people with learning disabilities. The high seizure frequency, resistance to treatments, associated skills deficit and co-morbidities make the management of epilepsy particularly challenging for people with learning disabilities. The Books Beyond Words booklet for epilepsy uses images to help people with learning disabilities manage their condition and improve quality of life. Our aim is to conduct a randomized controlled feasibility trial exploring key methodological, design and acceptability issues, in order to subsequently undertake a large-scale randomized controlled trial of the Books Beyond Words booklet for epilepsy.