Public Health Commons^™

A Single, Complete Touch: Population Health, The Health Contact Center, And The Patient Experience, Fran Horner, Susan Marks

Patient Experience Journal

As healthcare organizations turn to population health in order to more effectively manage the health and well-being of their patients, many need to ensure that these new strategies include a directive to improve the patient experience. Fortunately, healthcare systems can turn to an existing entity within its ranks, the health contact center, in order to execute a successful strategy and ensure that the individual patient never feels lost amongst the population crowd. Fran Horner from Singola Consulting and Susan Marks from Amati Health explore the ways in which population health and the health contact center work collaboratively to keep patient …

Randomized Clinical Trial Comparing Perioperative Care For Breast Cancer Patients At A Patient Hotel Versus A General Surgical Ward, Madleen Anna Camilla Huzell, Johan Frisack, Kristina Dalberg

Patient Experience Journal

Breast cancer is the most frequent cancer among women in Europe and the US. The aim of this study was to assess whether perioperative care, for breast cancer patients, provided at a patient hotel could be an alternative to the conventional care in an ordinary surgical ward. The study focuses solely on the patients’ experience of the provided care with a primary outcome that perioperative care at the patient hotel would be valued better than care in a general ward. Prospective, randomized single centre study. Between 2010 and 2012 a total of 151 patients < 80 years and without severe comorbidities were included in the trial, whereof 76 patients were randomised to the ward group and 75 patients to the hotel group. Five patients were excluded from each group. The validated IN2005-E questionnaire was used to evaluate the patients’ experiences of the care. The response rate was high with 65 patients answering the IN2005-E in each group. No difference could be found between the two groups regarding patient characteristics, type of surgery or tumour characteristics. The patients generally perceived the quality of the provided care as high. However, in the hotel group there was a better experience of care regarding issues such as coordination, privacy, some aspects of medical information, availability and the courtesy of the nurses. For selected patients, perioperative care at a patient hotel is an appreciated alternative to care at a surgical ward.

Patient Needs In Advanced Renal Cell Carcinoma: What Are Patients’ Priorities And How Well Are We Meeting Them?, Rick Harris, Kate Oake, Robert E. Hawkins, Robert J. Jones, Thomas Powles, David A. Montgomery

Patient Experience Journal

Treatment options and duration of therapy for patients with metastatic renal cell carcinoma (mRCC) have increased. Many patients now spend in excess of 2 years on active therapy. These patients’ needs, and the ability of health services to respond to them, are poorly understood. Ten patients living with mRCC for more than 2 years and treated with at least one targeted agent were selected at random from three hospitals in the United Kingdom (UK). One interviewer who was not involved in their care conducted in-depth interviews. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to identify issues of greatest …

The Comparative Impact Of Different Patient-Centered Medical Home Domains On Satisfaction Among Individuals Living With Type Ii Diabetes, Jon Mills, Allyson Hall, Rebecca Tanner, Jeffrey Harman, David L. Wood, Charles Lorbeer

Patient Experience Journal

Chronic illnesses like type 2 diabetes are costly and difficult to treat. Patient-centered medical homes (PCMH) have the potential to improve patient satisfaction in this population. However, which domains have the most impact on patient satisfaction has not been established. The aim of this study was to assess the relative strength of association between seven PCMH domains and two measures of satisfaction. Cross-sectional data were used in this observational study collected from a random sample of adults aged 18-89 with type 2 diabetes (n=1301) seen at 4 PCMHs. The Ambulatory Care Experiences Survey instrument was used to assess all measures. …

A Vision For Using Online Portals For Surveillance Of Patient-Centered Communication In Cancer Care, Hardeep Singh, Neeraj K. Arora, Kathleen M. Mazor, Richard L. Street Jr

Patient Experience Journal

The Veterans Health Administration (VHA) is charged with providing high-quality health care, not only in terms of technical competence but also with regard to patient-centered care experiences. Patient-centered coordination of care and communication are especially important in cancer care, as deficiencies in these areas have been implicated in many cases of delayed cancer diagnosis and treatment. Additionally, because cancer care facilities are concentrated within the VHA system, geographical and system-level barriers may present prominent obstacles to quality care. Systematic assessment of patient-centered communication (PCC) may help identify both individual veterans who are at risk of suboptimal care and opportunities for …

Impact Of Hospital Characteristics On Patients’ Experience Of Hospital Care: Evidence From 14 States, 2009-2011, Emily M. Johnston, Kenton J. Johnston, Jaeyong Bae, Jason M. Hockenberry, Ariel C. Avgar, Arnold Milstein Md, Mph, Sandra S. Liu, Ira Wilson, Edmund Becker

Patient Experience Journal

This paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in 10 hospital-reported patient experience-of-care scores by 29 characteristics classified as: patient characteristics, payer source, patient severity, hospital characteristics, hospital operations, and market characteristics. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores by hospital characteristics for 250 out of 290 HCAHPS-hospital characteristic combinations measured. We find fewer significant differences in changes in scores from 2009-2011 (135 out of …

Using A Process Improvement Tool To Improve Staff Skills & Enhance The Urgent Needs Patient Experience In A Women’S Health Center, Kenneth J. Feldman, Molly Lopez, Morris Gagliardi

Patient Experience Journal

NYC Health + Hospitals / Gouverneur serves more patients than any other diagnostic and treatment center in New York State. As part of the NYC Health + Hospitals public health care system, which serves 1.4 million patients and is the largest municipal health care delivery system in the United States, Gouverneur strives to serve the needs of both scheduled and unscheduled patients. Within Gouverneur, the Women’s Health department treats approximately 1,600 patients per month through approximately 2,100 visits. In September 2014, Gouverneur’s Women’s Health department launched a weeklong process improvement initiative known as a Rapid Improvement Event (RIE). Structured through …

Improving Process And Enhancing Parent And Therapist Satisfaction Through A Coordinated Intake Approach, Sharla Piecowye, Devona Gibson, Janis Carscadden, Kayla Ueland, Gregory Wells, Scott Oddie

Patient Experience Journal

Recent research indicates that, in Canada, approximately one in five children entering school are not meeting age appropriate milestones in physical, social, language, or cognitive development. Even where support services are available families often face barriers in accessing these. With the goals of improving access to programs, reducing barriers and increasing consistency and efficiency, a new Coordinated Intake Approach (CIA) was developed for families accessing Children’s Rehabilitation Services. It was expected that the CIA would result in 1) parents finding the intake process more satisfactory and easier to complete, 2) therapists feeling more supported and satisfied and 3) a decrease …

The Patient Patient: The Importance Of Knowing Your Navigator, Sarah M. Wheeler Phd, Julie E. Gilbert Phd, Melissa Kaan Mba, Eric Klonikowski, Claire Mb Holloway Md Phd Frcsc

Patient Experience Journal

In Ontario, Diagnostic Assessment Programs (DAPs) have been implemented to improve the quality of care patients receive during the diagnostic phase of the cancer journey. Patient navigators play a critical role in this model by coordinating care and providing information and support to patients and their families. The objectives of this study were 1) to determine whether patient navigation in DAPs is associated with a better patient experience and 2) to examine whether patient navigation in DAPs modifies the effect of wait times and patient volumes on patient experience. Data reflecting patients’ experience within the DAP were collected via survey …

Instruments To Measure The Inpatient Hospital Experience: A Literature Review, Kelly J. Edwards, Kim Walker, Jed Duff

Patient Experience Journal

Healthcare professionals worldwide are increasingly broadening their focus to include the experiences of patients and their family members as a means of assessing quality patient centered care. This paper seeks to identify and discuss instruments specifically designed to measure the inpatient hospital experience. A literature search focusing on pre-identified instruments as per the Health Foundation’s Helping Measuring Patient Centered Care database of measurement instruments (de Silva, 2014) and additional health databases (CINAHL, ERIC, EBSCO, HaPI, MEDLINE, PubMed and Psych INFO) was undertaken. Thirteen relevant instruments and seventeen associated studies (regarding instrument development and or validation) were identified. These instruments provide …

Conceptualising Multiple Conditions In Australia: First Steps To Systemic Change To Meet The Needs Of People With Serious Long-Term Illnesses, Christine F. Walker

Patient Experience Journal

Since the 1970s greater numbers of people are now living with several serious long term illnesses. These include rarer genetic conditions and ‘lifestyle conditions’ as well as those of an idiopathic nature. This article examines the growing need for new terms and concepts that reflect the changes in the lives of people living with long-term serious illnesses.

Members of the Chronic Illness Alliance attended a workshop where they presented their experiences and views of living with multi-morbidities. Consumers were concerned about treatment side-effects, polypharmacy, adverse events and the need for coordinated care. Following this workshop, the Chronic Illness Alliance undertook …

Should I Stay Or Should I Go? Patient Understandings Of And Responses To Source-Isolation Practices, Mary Wyer, Rick Iedema, Christine Jorm, Gary Armstrong, Su-Yin Hor, Claire Hooker, Debra Jackson, Clarissa Hughes, Matthew V.N. O'Sullivan, Gwendolyn L. Gilbert

Patient Experience Journal

Isolation of patients, who are colonised or infected with a multidrug-resistant organism (source-isolation), is a common practice in most acute health-care settings, to prevent transmission to other patients. Efforts to improve the efficacy of source-isolation in hospitals focus on healthcare staff compliance with isolation precautions. In this article we examine patients’ awareness, understandings and observance of source-isolation practices and directives with a view to understanding better the roles patients play or could play in transmitting, or limiting transmission, of multidrug-resistant organisms (MRO). Seventeen source-isolated adult surgical patients and two relatives participated in video-reflexive ethnography and interviews. We learned that, although …

The Effect Of Soothing Sound Machines And Meditation Using Cd Players On Relaxation In Acute Care Orthopedic Patients, Barbara Ellen Bauer, Carolyn Mitchell, Erin Salmon

Patient Experience Journal

This research studied the relaxation effect in orthopedic surgical patients using guided meditation or soothing sounds (SS) machines. The study used a comparative study design to evaluate differences in the effect of SS or guided meditation on patients’ perceptions of relaxation. IRB approval was obtained prior to initiating the study. A convenience sample of orthopedic surgery patients consented to voluntarily rate their perceptions of relaxation on a 5-point Likert scale ranging from “none”, “mild”, “moderate”, “good” or “very good”. A demographic survey was used to describe the sample. The sample included 50 patients with ages ranging from 40 to 70 …

Parents’ Experiences Of Neonatal Care In England, Sarah-Ann Burger Miss, Jenny King Miss, Amy Tallett Dr

Patient Experience Journal

With the greater need for specialist neonatal care in England over the last decade, increased attention has been given to developing and implementing quality measures to ensure that babies and their families receive the highest quality care. Patient experience is recognised as a key measure of quality, therefore it is essential to assess parents’ experiences of neonatal services to understand how these can be improved. In this paper we detail findings from the second large scale survey of parents’ experiences of neonatal care carried out in England in 2014, focusing on results that highlight aspects of family-centred care: information sharing; …

Managing Patient Expectations At Emergency Department Triage, Shital Shah, Anay Patel, Dino P. Rumoro, Samuel Hohmann, Francis Fullam

Patient Experience Journal

Emergency departments (ED) overcrowding, long wait, and uncomfortable waiting room conditions may lower perceived quality of the patient experience and satisfaction. This study investigates the relationship between patient satisfaction and communication of expected wait times, at the point of triage. A pre-post (11/4/ 2008 – 2/5/2009) group design with convenience sample (n=1,209) of all discharge adult ED patients was utilized for this study. A static expected wait time model (i.e., average wait time + one standard deviation) based on time of the day, day of the week and triage levels was employed to communicating expected wait time at triage while …

Patient And Family Partner Involvement In Staff Interviews: Designing, Implementing, And Evaluating A New Hiring Process, Sara-Grey M. Charlton, Shannon Parsons, Kimberly Strain, Agnes T. Black, Candy Garossino, Leanne Heppell

Patient Experience Journal

Healthcare organizations in Canada and the United States are seeking to enhance their ability to offer patient and family centred care (PFCC). One aspect of PFCC is the participation of Patient and Family Partners (PFPs) in a variety of roles within healthcare organizations. This article describes the creation and evaluation of a hiring process that utilized a PFCC interview tool (PFCCIT) and collaborated with PFPs in interviewing candidates for healthcare positions. An evaluation of the new hiring process was designed, including an on-line survey of candidates and semi-structured interviews with healthcare leaders and PFPs. Survey results indicated candidates felt the …

Bringing Patient Advisors To The Bedside: A Promising Avenue For Improving Partnership Between Patients And Their Care Team, Karine Vigneault, Johanne Higgins, Marie-Pascale Pomey, Josée Arsenault, Valérie Lahaie, Audrey-Maude Mercier, Olivier Fortin, Alain M. Danino

Patient Experience Journal

This paper presents an innovative model of care, which brings patients who have already been through a similar experience of illness (patient advisors) directly to the bedside of patients, where they are viewed as full-fledged members of the clinical team. As part of a pilot project, three patient advisors were recruited and met with patients who had sustained a traumatic amputation and were admitted to the only center of expertise in replantation of the upper limb in Canada. Several individual interviews and focus groups with patients and patient advisors have revealed very promising results. Indeed, patients have expressed …

Patient Leadership: Taking Patient Experience To The Next Level?, David Mcnally, Steve Sharples, Georgina Craig, Dr Anita Goraya, Frcgp

Patient Experience Journal

NHS England commissioned the project described in this article to explore how patients and carers can, acting as leaders, make a real difference in improving experience of care. The work was carried out on a collaborative basis, co-designing the scope of the research with patient leaders and commissioners. We gathered case examples across England that had involved patient leaders in using patient and carer feedback to improve experience of care. A Patient Leaders Expert Advisory Group selected four case examples that were visited to undertake a more detailed study and subsequently discussed and agreed the key learning points and conclusions. …

The Critical Role Of Family In Patient Experience, Brian Boyle

Patient Experience Journal

In this commentary Brian Boyle raises a simple, yet critical point about the value of family in the care experience. He offers, "When you are focusing on the goals for the patient's recovery, the doctors work with the nurses, specialists, and patient's family to decide on the appropriate care plan for the patient on both a short- and long-term basis. It is vital that this multi-disciplinary approach occurs during the formation of the care plan and is frequently updated as time goes on. The loved ones of a patient may not have a medical license or healthcare background, but their …

The State Of Patient Experience, Jason A. Wolf Phd

Patient Experience Journal

As the patient experience movement continues to flourish, there is greater alignment that experience encompasses all we do in healthcare – not simply a customer encounter, but how we engage people in mind, body and spirit, how we integrate the critical aspects of care from quality to safety to service and how we link the very complexities of our healthcare systems globally to provide for easy journeys for those receiving care. In sharing data from the latest study for The Beryl Institute on patient experience, the trends of this growing movement are seen as positive and a set of clear …

Virtual Rounds: Improving Family Participation In Multidisciplinary Rounds Via Telehealth, Gerald Durkan

CwiC Posters

Background

What Are Multidisciplinary Care Rounds (MDR’s)?

MDRs are defined by the unique characteristic of incorporating a multitude of both physician and non-physician specialties into the conversation with the patient for the coordination of their care.

What is Discussed During an MDR?

Activities relating to the care of the patient that may be incorporated into the MDR include summarizing the treatment that the patient has undergone, discussing the treatment approach that is planned for the patient, working through potential issues that may arise from the treatments, and discussing the potential future therapy.

What is Telehealth?

Telehealth is the delivery of …

Lost In Legislation: Barriers In Actualization Of Post-Apartheid Healthcare Reform In South Africa And American Analogies, Abbie Marie Bender

CwiC Posters

Introduction

A nation now defined by the intersection of the Western and Non-Western worlds, South Africa’s evolving healthcare system provides an invaluable reference for the perils that segregation and class control can create for large groups of a population. Under apartheid, the system propagated such separation in the availability and delivery of medicine to its peoples in a caste-like manner. To be of Western descent in South Africa was a ticket that admitted one to the amenities of Western medicine; those without the whiteness of such validating paper found themselves trapped in substandard care. As apartheid was dissolved with the …

Improving Rural Community Health Through Care Coordination, Alexander Miller

CwiC Posters

DEMOGRAPHICS OF CRAWFORD COUNTY^1,2

• Population – 87,600
• Population density – 86.5 per mi²
• Ratio of patients to PCPs – 1,685:1
• Number of hospitals – 2
• Population 65 and older – 17.4%
• Overweight – 65% Obesity – 32%
• Population with Diabetes – 12%
• Heart disease death rate – 200 deaths per 100,000 people.

The above percentages and rates of disease are either equal to or higher than the averages for the state of Pennsylvania.

How A Civil War Surgeon’S Population Health Initiatives Helped Save The Union, 2lt Tyler Walker

CwiC Posters

Introduction

Dr. Jonathan Letterman was the medical director for the Army of the Potomac during the American Civil War. Dr. Letterman graduated from Jefferson Medical College in Philadelphia in 1849. With his appointment to the largest portion of the Union Army, Dr. Letterman was tasked with improving what would today be called a population health nightmare. Soldiers lived in filth, ate food devoid of nutrition, were forced to train beyond what was necessary no matter the conditions, and worst of all, were not provided with an organized medical department to treat them if they were wounded or became ill. He …

The Public Health Of Youth And High School Athletics, Michael Haines

CwiC Posters

The Problem

• The number of participants in high school sports has increased since 1989 (National Federation of State HS Association).
• From 2000-2010 7% of public schools cut athletic programs while less than 1% added them (Sharp Center Univ. Michigan).
• Some estimates predict 27% of public high schools will not offer varsity athletics by 2020 (Sharp Center Univ. Michigan).
• School’s are dropping athletic programs (as well as music and theater programs) due to budget cuts.
• Alternative approaches schools are taking include “pay to play” which increases the financial burden on students and families.
• In 2011, 3 out of 4 school districts …

Developing Maternal And Child Health Curriculum In Rural Uganda, Rebecca Newbrander, Md Candidate

CwiC Posters

Maternal and Child Health in Iganga District Uganda

Maternal and child health outcomes in the East Central Region of Uganda are especially poor compared to the rest of Uganda [1]:

• Only 32% of women (50.7% nationally) informed about signs of pregnancy or delivery complications
• Only 12% of women (62% nationally) received malaria prophylaxis during pregnancy

The “Three Delays Model” of barriers to care[3]:

• Knowing when to seek care and making the decision to do so
• Access to care once decision is reached to seek it
• Receiving quality care at a health center or hospital

Maternal and Child Heath Care in …

School Wellness Assessment: Creating A Culture Of Health, Kaitlyn Petruccelli, Bs, Rickie Brawer, Mph, Phd

CwiC Posters

Introduction

The Center for Urban Health (CUH) and the Office for Student Life and Engagement at Thomas Jefferson University (TJU) are working with two public elementary schools in Philadelphia – Southwark School and Independence Charter School – to create a culture of health in the schools. Both schools wish to establish an environment that promotes health and safety and assists children in developing life-long healthy habits. The offices at TJU set out a plan to

(1) Assess the current policies and climate at the schools,

(2) Identify priority weaknesses to address,

(3) Connect TJU’s various health professional schools and student …

Jeffhealth Medical Student Exchange In Rwanda, Amanda Nemecz, Alexander Rowan, Talia Stark

CwiC Posters

Teaching Community Health Workers

In rural Rwandan villages, the communities are linked to healthcare through Community Health Workers (CHW). CHW are appointed based on village election and the requirement that they can read and write. The Rwandan Ministry of Health provides general health training to the CHW so that they can educate and advise the village on health related matters. CHW administer educational sessions at village meetings about prevalent health issues, and advise members of the village when they should go to the Health Center. JeffHEALTH’s teaching aims to supplement the Ministry of Health training. Topics are chosen and approved …

Clinical Experience At Pasteur Clinic Đà Lạt, Vietnam, Emma Howard-Young, Jordan Howard-Young, Ma

CwiC Posters

History of the Pasteur Clinic Đà Lạt

The Pasteur Clinic is associated with the Institut Pasteur, part of the international network of research institutes dedicated to the prevention and treatment of infectious diseases. The Đà Lạt branch of Vietnam’s Institut Pasteur was built between 1930 and 1936 under the direction of Dr. Alexandre Yersin, a physician remembered for identifying Yersinia pestis as the causative agent of Plague and a student of the eponymous French chemist and microbiologist Louis Pasteur. While many overt references to the French colonial tradition have been supplanted in Vietnam by nationalist sentiments, the Institut Pasteur …

The Intersection Between Medication Tablets And Electronic Tablets: Determining The Usability And Acceptability Of A Patient-Centered Cardiovascular Risk Assessment (Pccra) Ios App, Nisha Patel, Ms2, Geoffrey Mills, Md, Phd, Marianna Lanoue, Phd, Amy Cunningham, Mph

CwiC Posters

Background

One American dies from cardiovascular disease (CVD) every 40 seconds. Risk factor awareness, assessment, and communication has been shown to improve efficacy of patient treatment and also decline overall risk in the population over time. Traditional cardiac risk assessment tools (e.g. Framingham risk assessment, FRA) generate a risk score in a format that may not appreciated or easily understood by all patients. A new patient-centered approach, in which the patient becomes an active participant in the decision-making process, has shown significant increase in patient-provider communication and diagnosis/management.