How older adults with multimorbidity manage their own care within a formal care coordination program?

As the number of older adults with multimorbidity increases, care coordination programs are being designed to streamline the complex care older adults receive from multiple providers by improving health and reducing unnecessary costs. Well-coordinated care requires actions by both patients and providers. Yet little attention is paid to the what older adults do to manage their own care alongside a formal Care Coordination Program (CCP). This paper presents a qualitative descriptive study that explored what actions older adults took on their own to manage their care. Findings from this study identified that there were two actions older adults took to manage their care; they lived within their limits and they lived with grit. This study suggests that by recognizing what older adults do to self-manage their care within the context of a CCP, nurses can build on older adults' actions and provide person-centered strategies for care coordination.

Early Identification of Family Physicians Using Qualitative Admissions Data.

BACKGROUND AND OBJECTIVES: The medical community has been concerned about the shortage of family physicians for decades. Identification of likely family medicine (FM) student matches early in medical school is an efficient recruitment tool. The objective of this study was to analyze qualitative data from medical school applications to establish themes that differentiate future family physicians from their non-FM counterparts. METHODS: We conducted a qualitative analysis of admissions essays from two groups of 2010-2019 medical school graduates: a study group of students who matched to FM (n=135) and a random sample comparison group of non-FM matches (n=136). We utilized a natural language modeling platform to recognize semantic patterns in the data. This platform generated keywords for each sample, which then guided a more traditional content analysis of the qualitative data for themes. RESULTS: The two groups shared two themes: emotions and science/academics, but with some differences in thematic emphasis. The study group tended toward more positive emotions and the comparison group tended to utilize more specialized scientific language. The study group exhibited two unique themes: special interests in service and community/people. A secondary theme of religious faith was evident in the FM study group. The comparison group exhibited two unique themes: lab/clinical research and career aspirations. CONCLUSIONS: Aided by machine learning, a novel analytical approach revealed key differences between FM and non-FM student application materials. Findings suggest qualitative application data may contain identifiable thematic differences when comparing students who eventually match into FM residency programs to those who match into other specialties. Assessing student potential for FM could help guide recruitment and mentorship activities.

Increasing healthcare workforce diversity: Urban universities as catalysts for change.

Increasing the diversity of the healthcare workforce is often cited as a strategy for reducing racial and ethnic health disparities. Colleges and universities are uniquely positioned to influence workforce diversity through their recruitment, admissions, and student support practices, and by partnering with community groups to improve the pipeline of underrepresented racial/ethnic (URE) students pursuing health careers and influence workforce diversity practices in healthcare institutions. In this article, the authors describe a multifaceted initiative implemented by the Academic Health Center (AHC) at the University of Cincinnati (UC) that sought to address each of these areas. The initiative was led by the dean of the College of Nursing and a professor from the College of Medicine, who served as co-principal investigators. Within the university, UC identified improving health disparities and workforce diversity as central to its mission, adopted holistic admissions practices, used social media to strengthen outreach to URE students, and created a diversity dashboard to monitor diversity efforts. Additionally, UC partnered with community groups to expand pipeline programs for URE students and worked with a community advisory board to engage the region's health systems in evaluating their workforce diversity efforts. Within the College of Nursing, the initiative resulted in increased applications from students at pipeline schools, a larger number of URE student admissions, and increased faculty diversity.

An Academic-Community Partnership to Improve Health Care Workforce Diversity in Greater Cincinnati: Lessons Learned.

BACKGROUND: The University of Cincinnati (UC) participated in a learning collaborative aimed at preparing a culturally sensitive, diverse, and prepared health workforce. OBJECTIVES: Describe the development, accomplishments, and lessons learned of an academic-community partnership vested in improving health care workforce diversity and health disparities in the Greater Cincinnati region. METHODS: Researchers created a Community Advisory Board (CAB) consisting of university, community, and health system representatives. The CAB addressed gaps in workforce diversity data and catalyzed the formation of new regional partnerships, resulting in a multipronged strategy for improving health workforce diversity and health disparities. LESSONS LEARNED: The academic-community partnership was enhanced by composition of the CAB and inclusion of diverse, credible, and collaborative partners; cultural humility by academic researchers; establishment of trust and respect; and a shared commitment to common goals. CONCLUSIONS: By sharing decision making with the CAB, academic researchers expanded their engagement and influence on community issues.

The art of observation: impact of a family medicine and art museum partnership on student education.

BACKGROUND AND OBJECTIVES: Compared to verbal communication, teaching the skill of observation is often shortchanged in medical education. Through a family medicine-art museum collaboration, we developed an elective course for second-year medical students titled the "Art of Observation" (AOO). To evaluate the course's effect on clinical skills, we performed a qualitative evaluation of former students during their clinical rotations. METHODS: In the spring of 2005, all students who had completed the AOO course in 2003 or 2004 were invited to take part in an online evaluation consisting of eight journaling survey questions. Students were instructed to answer the survey questions with specific examples. Question areas included the most memorable experience, the course's influence on the doctor-patient relationship, usefulness during clinical years of medical school, and skills unique to AOO. The anonymous data were analyzed qualitatively, coding the responses to categories derived from the data, leading to the formation of themes. RESULTS: Of the 19 students eligible, 17 participated. We found three important themes: (1) the AOO positively influenced clinical skills, (2) both art museum exercises and a clinical preceptorship were necessary to achieve those skills, and (3) the AOO led to a sense of personal development as a physician. In addition, students told us that the training in observation and description skills they learned were unique to the AOO. CONCLUSIONS: This collaboration between a department of family medicine and an art museum produced a course that facilitated observational skills used in successful doctor-patient relationships.

How respected family physicians manage difficult patient encounters.

BACKGROUND: Nearly all family physicians have patients that engender a sense of frustration or dislike, often described as "difficult." Most research in this area focuses on describing these patients and their physicians, not management or coping. OBJECTIVE: To describe how respected family physicians identify, manage, and cope with difficult patient encounters. METHODS: Qualitative semi-structured interview study. Participant physicians described as "excellent" were recommended by medical school family medicine faculty around the county. Interview questions included "describe the patient you least like seeing," and "how do you keep sane but still assure adequate care for the patient?" Interviews were analyzed using the editing method, looking for common categories and themes. RESULTS: 102 physicians were interviewed. Physicians described both patient behaviors (stay sick and demanding) as well as medical problems (multiple, chronic pain, drug seeking, psychiatric) that they found frustrating. Difficult encounters occurred when these patient behaviors and medical problems clashed with physicians' personal and practice traits. Their management strategies to return the encounter to success incorporated collaboration, appropriate use of power and empathy. CONCLUSIONS: We propose a model where clashes between patient behaviors and physicians' traits turn a successful encounter of collaboration, appropriate use of power and empathy into a difficult encounter of opposition, misuse of power and compassion fatigue. Management strategies used by our participants aim to return success to the encounter and may serve as a guide for practicing physicians and for future research.