Validating Psychometric Properties of a Revised Patient Version of the Combined Assessment of Psychiatric Environments (CAPE).

BACKGROUND: Measuring patient experience is an essential challenge in the inpatient behavioral health population. AIM: This initiative analyzed the psychometric properties of a revised version of the patient Combined Assessment of Psychiatric Environments (p-CAPE-R) survey. METHODS: The p-CAPE was revised to encompass the interdisciplinary treatment team and implemented on five inpatient psychiatric units at an academic medical center. A psychometric analysis was performed on the p-CAPE-R. RESULTS: Analysis of factor loadings with a large sample (n = 786) revealed a more coherent item structure under the "staff competency and engagement" and "treatment effectiveness" domains than presented in the original instrument development research. CONCLUSIONS: Although the p-CAPE-R reflects a more useful and psychometrically sound instrument than the original p-CAPE, further analysis and revision to reflect the entire interdisciplinary team is warranted.

Breastfeeding During a Pandemic: The Influence of COVID-19 on Lactation Services in the Northeastern United States.

BACKGROUND: Pandemic-related restrictions have limited traditional models of lactation support. RESEARCH AIMS: The primary aim of this study was to determine changes to breastfeeding support services during the coronavirus-2019 pandemic according to trained lactation providers. The secondary aim was to assess strengths and limitations of telehealth services. METHODS: A prospective survey was conducted entirely online using the Qualtrics platform during June 2020. Gatekeepers at Connecticut agencies and breastfeeding networks were forwarded an anonymous survey link to distribute to eligible lactation staff. RESULTS: A variety of participants (N = 39) completed the survey and the majority (69.2%; n = 27) were providing only telehealth services. More than half (58.1%; n = 18) of the participants who conducting telehealth in any form, found that virtual lactation support was moderately effective compared to in-person support. Weakness of virtual support included technical and logistical difficulties, challenges assisting with latching or reading body language over the phone or online, and accurately assessing infant growth. Strengths related to virtual support included the flexibility and convenience of home-based support, expanded communication strategies, and safety from virus exposure. Further, visits with a lactation professional decreased significantly during the pandemic. Limited in-hospital and pediatrician support were also noted, particularly among groups without access to telehealth resources. CONCLUSIONS: As a result of the pandemic and associated shifts in lactation services, breastfeeding disparities may be further exacerbated among those without equitable access to lactation support. Challenges and innovations in virtual support may influence adaptive options in the field moving forward.

Incorporating Future of Nursing Competencies Into a Clinical and Simulation Assessment Tool: Validating the Clinical Simulation Competency Assessment Tool.

AIM: The purpose of the study was to evaluate the validity of the Clinical Simulation Competency Assessment Tool (ClinSimCAT). BACKGROUND: The 2011 Future of Nursing report encouraged nursing programs to move toward a competency-based approach to education. As no tool was found to holistically evaluate nursing student competency in clinical and simulation settings, we developed the ClinSimCAT based on the Institute of Medicine recommended competencies. METHOD: A Delphi study with three rounds was conducted. A national sample of nursing education and simulation leaders was used to achieve consensus about the competencies. RESULTS: The process resulted in a set of 20 competencies across eight domains (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, informatics, professionalism, and systems-based practice). CONCLUSION: The ClinSimCAT has demonstrated evidence of content validity and can be used for evaluation of clinical and simulation across a variety of undergraduate nursing courses.

A Population Health Management Approach to Oral Health.

Clinical outcomes have been shown to be better, and total costs lower, when patients with chronic illness such as diabetes are managed using a population health strategy in a primary care setting that includes structured coordination of care with specialty services. This "population health management approach" offers a promising new vision for addressing oral disease as a chronic illness through a collaborative partnership between primary care teams and dental professionals.

The safety net medical home initiative: transforming care for vulnerable populations.

BACKGROUND: Despite findings that medical homes may reduce or eliminate health care disparities among underserved and minority populations, most previous medical home pilot and demonstration projects have focused on health care delivery systems serving commercially insured patients and Medicare beneficiaries. OBJECTIVES: To develop a replicable approach to support medical home transformation among diverse practices serving vulnerable and underserved populations. DESIGN: Facilitated by a national program team, convening organizations in 5 states provided coaching and learning community support to safety net practices over a 4-year period. To guide transformation, we developed a framework of change concepts aligned with supporting tools including implementation guides, activity checklists, and measurement instruments. SUBJECTS: Sixty-five health centers, homeless clinics, private practices, residency training centers, and other safety net practices in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania. MEASURES: We evaluated implementation of the change concepts using the Patient-Centered Medical Home-Assessment, and conducted a survey of participating practices to assess perceptions of the impact of the technical assistance. RESULTS: All practices implemented key features of the medical home model, and nearly half (47.6%) implemented the 33 identified key changes to a substantial degree as evidenced by level A Patient-Centered Medical Home-Assessment scores. Two thirds of practices that achieved substantial implementation did so only after participating in the initiative for >2 years. By the end of the initiative, 83.1% of sites achieved external recognition as medical homes. CONCLUSIONS: Despite resource constraints and high-need populations, safety net clinics made considerable progress toward medical home implementation when provided robust, multimodal support over a 4-year period.

Assessing progress toward becoming a patient-centered medical home: an assessment tool for practice transformation.

OBJECTIVE: To describe the properties of the Patient-Centered Medical Home Assessment (PCMH-A) as a tool to stimulate and monitor progress among primary care practices interested in transforming to patient-centered medical homes (PCMHs). STUDY SETTING: Sixty-five safety net practices from five states participating in a national demonstration program for PCMH transformation. STUDY DESIGN: Longitudinal analyses of PCMH-A scores were performed. Scores were reviewed for agreement and sites were categorized over time into one of five categories by external facilitators. Comparisons to key activity completion rates and NCQA PCMH recognition status were completed. DATA COLLECTION/EXTRACTION METHODS: Multidisciplinary teams at each practice completed the 33-item self-assessment tool every 6 months between March 2010 and September 2012. PRINCIPAL FINDINGS: Mean overall PCMH-A scores increased (7.2, March 2010, to 9.1, September 2012; [p < .01]). Increases were statistically significant for each of the change concepts (p < .05). Facilitators agreed with scores 82% of the time. NCQA-recognized sites had higher PCMH-A scores than sites that were not yet recognized. Sites that completed more transformation activities and progressed over defined tiers reported higher PCMH-A scores. Scores improved most in areas where technical assistance was provided. CONCLUSIONS: The PCMH-A was sensitive to change over time and provided an accurate reflection of practice transformation.

Employer approaches to preconception care.

In recent years, the idea of preconception care-education, counseling, and interventions delivered to women before they become pregnant--has gained traction as a critically important health promotion opportunity for women and their families. Employers, as purchasers of health care and as providers of wellness services, have an important role to play in the promotion of preconception care. Large, self-insured employers can craft their medical benefit plans to include evidence-informed preventive health benefits such as preconception care. Employers can also design and implement worksite health promotion programs that address preconception, pregnancy, and postpartum health. And employers of all sizes can educate women and their partners on pregnancy health through tailored communication. This article provides an overview of the business case for preconception care and concrete steps employers can take to support and incent preconception care among their beneficiaries. The article also includes suggestions on ways providers and health professionals support employers in these efforts.