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1.
Prof Case Manag ; 26(2): 62-69, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33507016

RESUMEN

PURPOSE: Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease known as COVID-19, case management has emerged as a critical intervention in the treatment of cases, particularly for patients with severe symptoms and medical complications. In addition, case managers have been on the front lines of the response across the health care spectrum to reduce risks of contagion, including among health care workers. The purpose of this article is to discuss the case management response, highlighting the importance of individual care plans to provide access to the right care and treatment at the right time to address both the consequences of the disease and patient comorbidities. PRIMARY PRACTICE SETTINGS: The COVID-19 response spans the full continuum of health and human services, including acute care, subacute care, workers' compensation (especially catastrophic case management), home health, primary care, and community-based care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: From the earliest days of the pandemic, case managers have assumed an important role on the front lines of the medical response to COVID-19, ensuring that procedures are in place for managing a range of patients: those who were symptomatic but able to self-isolate and care for themselves at home; those who had serious symptoms and needed to be hospitalized; and those who were asymptomatic and needed to be educated about the importance of self-isolating. Across the care spectrum, individualized responses to the clinical and psychosocial needs of patients with COVID-19 in acute care, subacute care, home health, and other outpatient settings have been guided by the well-established case management process of screening, assessing, planning, implementing, following up, transitioning, and evaluating. In addition, professional case managers are guided by values such as advocacy, ensuring access to the right care and treatment at the right time; autonomy, respecting the right to self-determination; and justice, promoting fairness and equity in access to resources and treatment. The value of justice also addresses the sobering reality that people from racial and ethnic minority groups are at an increased risk of getting sick and dying from COVID-19. Going forward, case management will continue to play a major role in supporting patients with COVID-19, in both inpatient and outpatient settings, with telephonic follow-up and greater use of telehealth.


Asunto(s)
/enfermería , Manejo de Caso/normas , Enfermería de Cuidados Críticos/educación , Personal de Salud/educación , Personal de Salud/psicología , Planificación de Atención al Paciente/normas , Atención Dirigida al Paciente/normas , Adulto , Manejo de Caso/estadística & datos numéricos , Curriculum , Educación Continua en Enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Planificación de Atención al Paciente/estadística & datos numéricos , Atención Dirigida al Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto
4.
Methodist Debakey Cardiovasc J ; 16(3): 220-224, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33133358

RESUMEN

Improving patient experience is a fundamental component of patient-centered care and one of the key strategies for improving health care quality, delivery, and outcomes. Several studies have described the association between improved patient experience and better health outcomes among individuals with cardiovascular disease. These findings are important given that cardiovascular disease is a leading cause of morbidity and mortality in the United States and globally. This review summarizes the findings on patient-reported health care experiences and discusses how optimizing these experiences may be a tool to improve health outcomes among individuals with cardiovascular disease.


Asunto(s)
Enfermedades Cardiovasculares/terapia , Participación del Paciente , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Atención Dirigida al Paciente , Enfermedades Cardiovasculares/diagnóstico , Toma de Decisiones Conjunta , Humanos , Atención Dirigida al Paciente/normas , Relaciones Médico-Paciente , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud
5.
Obstet Gynecol ; 136(5): 1001-1005, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030869

RESUMEN

Patient-centered care is one of the six aims for improvement in health care quality outlined by the National Academy of Medicine (previously known as the Institute of Medicine). We propose an algorithm for patients who are presenting with a pregnancy of unknown location that emphasizes pregnancy desiredness to improve patient-centered care. Health care professionals should assess pregnancy desiredness at a patient's initial consultation for evaluation of pregnancy of unknown location; desiredness, along with other clinical criteria, should guide management. For women with an undesired pregnancy, health care professionals should offer expedient active management. Uterine aspiration will allow for quick clinical diagnosis and resolution of the pregnancy. Alternatively, for women with a desired pregnancy or for those who are ambivalent, we recommend careful conservative management. Adopting this algorithm will recenter the patient in the complex management of pregnancy of unknown location.


Asunto(s)
Atención Dirigida al Paciente/normas , Embarazo Ectópico/diagnóstico , Embarazo no Deseado/psicología , Atención Prenatal/normas , Calidad de la Atención de Salud/normas , Algoritmos , Femenino , Humanos , Embarazo , Embarazo Ectópico/psicología , Atención Prenatal/métodos , Atención Prenatal/psicología
6.
Obstet Gynecol ; 136(4): 859-867, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32976375

RESUMEN

Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine, and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.


Asunto(s)
Aberraciones Cromosómicas , Trastornos de los Cromosomas , Consejo , Enfermedades Fetales , Pruebas Genéticas/métodos , Diagnóstico Prenatal/métodos , Trastornos de los Cromosomas/diagnóstico , Trastornos de los Cromosomas/genética , Consejo/métodos , Consejo/normas , Consejo/provisión & distribución , Femenino , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/genética , Accesibilidad a los Servicios de Salud/normas , Humanos , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Guías de Práctica Clínica como Asunto , Embarazo , Estados Unidos
7.
Lancet Diabetes Endocrinol ; 8(10): 855-867, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32946822

RESUMEN

Older adults with diabetes are heterogeneous in their medical, functional, and cognitive status, and require careful individualisation of their treatment regimens. However, in the absence of detailed information from clinical trials involving older people with varying characteristics, there is little evidence-based guidance, which is a notable limitation of current approaches to care. It is important to recognise that older people with diabetes might vary in their profiles according to age category, functional health, presence of frailty, and comorbidity profiles. In addition, all older adults with diabetes require an individualised approach to care, ranging from robust individuals to those residing in care homes with a short life expectancy, those requiring palliative care, or those requiring end-of-life management. In this Review, our multidisciplinary team of experts describes the current evidence in several important areas in geriatric diabetes, and outlines key research gaps and research questions in each of these areas with the aim to develop evidence-based recommendations to improve the outcomes of interest in older adults.


Asunto(s)
Envejecimiento , Diabetes Mellitus/terapia , Atención Dirigida al Paciente/normas , Guías de Práctica Clínica como Asunto/normas , Anciano , Anciano de 80 o más Años , Humanos
8.
PLoS One ; 15(9): e0238356, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991624

RESUMEN

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Enfermedad Crónica/terapia , Comunicación , Disparidades en Atención de Salud , Hispanoamericanos/estadística & datos numéricos , Atención Dirigida al Paciente/normas , Relaciones Médico-Paciente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Estudios de Seguimiento , Humanos , Cobertura del Seguro , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Pronóstico , Racismo/estadística & datos numéricos
9.
Health Qual Life Outcomes ; 18(1): 288, 2020 Aug 24.
Artículo en Inglés | MEDLINE | ID: mdl-32831086

RESUMEN

PURPOSE: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called 'WellNet'. METHODS: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. RESULTS: Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID. CONCLUSION: Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.


Asunto(s)
Atención Dirigida al Paciente/normas , Calidad de Vida , Anciano , Australia , Enfermedad Crónica/psicología , Enfermedad Crónica/terapia , Estudios Controlados Antes y Después , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diferencia Mínima Clínicamente Importante , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
10.
Obstet Gynecol ; 136(4): e48-e69, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32804883

RESUMEN

Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.


Asunto(s)
Aberraciones Cromosómicas , Trastornos de los Cromosomas , Consejo , Enfermedades Fetales , Pruebas Genéticas/métodos , Diagnóstico Prenatal/métodos , Trastornos de los Cromosomas/diagnóstico , Trastornos de los Cromosomas/genética , Consejo/métodos , Consejo/normas , Consejo/provisión & distribución , Femenino , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/genética , Accesibilidad a los Servicios de Salud/normas , Humanos , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Embarazo , Estados Unidos
11.
Health Qual Life Outcomes ; 18(1): 241, 2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-32690091

RESUMEN

BACKGROUND: With a shift in the healthcare paradigm towards a more patient-centered approach, data on inflammatory bowel disease (IBD) needs to be further explored. This study aimed to determine patient perspectives on the effect of IBD and features of patients with lower satisfaction level and compare patient and physician perception of IBD-related Quality of Care (QoC). METHODS: A previously developed pre-standardised set of questions regarding patient-centered outcome (PRO) measures for IBD, comprising 36 items, was administered in five centers, and a concomitant questionnaire for specialised physicians was adapted and administered. RESULTS: Overall, 1005 patients with IBD met the inclusion criteria. Sixty-five questionnaires were administered to specialised physicians. Both patients and physicians perceived the IBD-related QoC as being satisfactory. Furthermore, this study revealed areas of shortcomings where it comes to patient perceptions. Female sex and the presence of negatively impacting disease characteristics (presence of significant pain or discomfort, lack of energy, feeling fatigued most of the time, experiencing anxiety or depression in the last 2 weeks) were associated with lower satisfaction levels. CONCLUSIONS: Our findings can be used in establishing strategies aimed at improving patient QoC and defining strategic priorities. These data can aid in improving the communication of the pressing needs of IBD patients, to both the public payers and health authorities.


Asunto(s)
Enfermedades Inflamatorias del Intestino/psicología , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Adulto , Anciano , Consenso , Estudios Transversales , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/terapia , Masculino , Persona de Mediana Edad , Atención Dirigida al Paciente/normas , Calidad de la Atención de Salud/normas , Calidad de Vida , Adulto Joven
12.
PLoS One ; 15(7): e0236019, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32667953

RESUMEN

BACKGROUND: Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. METHODS AND FINDINGS: Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. CONCLUSIONS: Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.


Asunto(s)
Promoción de la Salud/normas , Informática Médica/normas , Atención Dirigida al Paciente/normas , Atención Primaria de Salud/normas , Mejoramiento de la Calidad , Calidad de la Atención de Salud/normas , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto Joven
13.
Rev Lat Am Enfermagem ; 28: e3272, 2020.
Artículo en Portugués, Español, Inglés | MEDLINE | ID: mdl-32491126

RESUMEN

OBJECTIVE: to analyze the experience of the patient during hospitalization, focusing on the co-production of care related to patient safety protocols. METHOD: qualitative study, whose data were collected through the triangulation of multiple sources: document analysis, observation of 10 professionals in the provision of care and 24 interviews with patient-families from 12 clinical and surgical inpatient units of a hospital. Thematic analysis was carried out, based on the concept of co-production. RESULTS: safety protocols according to the experience of the patient portrayed the role of patient-families as co-producers of safe care. It was found an alignment between perceptions of the patients, institutional definitions and basic national and international patient safety protocols. However, these protocols are not always followed by professionals. CONCLUSION: co-production was perceived in the protocols for safe surgery and prevention of injuries resulting from falls. In patient identification, hand hygiene and medication process, it was found that co-production depends on the proactive behavior of patient-families, as it is not encouraged by professionals. The research contributes with subsidies to leverage the participation of the patient as an agent of their safety, highlighting the co-production of health care as a valuable resource for advancing patient safety.


Asunto(s)
Familia , Hospitalización/estadística & datos numéricos , Seguridad del Paciente/normas , Atención Dirigida al Paciente/normas , Accidentes por Caídas/prevención & control , Adulto , Anciano , Brasil , Protocolos Clínicos , Femenino , Higiene de las Manos , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
14.
Top Magn Reson Imaging ; 29(3): 131-134, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32568975

RESUMEN

Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients' motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.


Asunto(s)
Comunicación , Imagen por Resonancia Magnética/métodos , Satisfacción del Paciente , Atención Dirigida al Paciente/métodos , Humanos , Imagen por Resonancia Magnética/normas , Grupo de Atención al Paciente , Educación del Paciente como Asunto , Atención Dirigida al Paciente/normas , Relaciones Profesional-Paciente , Calidad de la Atención de Salud , Radiología/educación , Radiología/métodos
15.
Curr Oncol ; 27(2): 90-99, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32489251

RESUMEN

Background: Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods: The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results: The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions: Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Oncología Médica/estadística & datos numéricos , Neoplasias/terapia , Medición de Resultados Informados por el Paciente , Atención Dirigida al Paciente/estadística & datos numéricos , Canadá , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/normas , Humanos , Oncología Médica/métodos , Oncología Médica/normas , Neoplasias/diagnóstico , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Calidad de Vida
16.
Int J Med Inform ; 139: 104132, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32416522

RESUMEN

BACKGROUND: In institutional dementia care, person-centered care improves care processes and the quality of life of residents. However, communication gaps impede the implementation of person-centered care in favor of routinized care. OBJECTIVE: We evaluated whether self-organizing knowledge management reduces communication gaps and improves the quality of person-centered dementia care. METHOD: We implemented a self-organizing knowledge management system. Eight significant others of residents with severe dementia and six professional caregivers used a mobile application for six months. We conducted qualitative interviews and focus groups afterward. MAIN FINDINGS: Participants reported that the system increased the quality of person-centered care, reduced communication gaps, increased the task satisfaction of caregivers and the wellbeing of significant others. CONCLUSIONS: Based on our findings, we develop the following hypotheses: self-organizing knowledge management might provide a promising tool to improve the quality of person-centered care. It might reduce communication barriers that impede person-centered care. It might allow transferring content-maintaining tasks from caregivers to significant others. Such distribution of tasks, in turn, might be beneficial for both parties. Furthermore, shared knowledge about situational features might guide person-centered interventions.


Asunto(s)
Cuidadores/normas , Comunicación , Demencia/terapia , Gestión del Conocimiento/normas , Atención Dirigida al Paciente/normas , Autocuidado , Grupos Focales , Humanos , Satisfacción del Paciente , Investigación Cualitativa , Calidad de Vida
17.
J Clin Nurs ; 29(15-16): 2967-2978, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32453484

RESUMEN

AIM AND OBJECTIVES: This study aimed to explore the effects of person-centred care on their job productivity, job satisfaction and organisational commitment among employees in long-term care facilities. BACKGROUND: Person-centred care has been regarded as the best caregiving model for long-term care facilities. Few studies tested the impact of person-centred care on employee performance. DESIGN: A cross-sectional study was employed. METHODS: This study sent 373 samples with self-report questionnaires to the employees of sixteen long-term care facilities in Taiwan. A total of 366 valid samples were collected. A 33-item person-centred care questionnaire with Likert-scale responses was developed to assess the extent of person-centred care. We adopted hierarchical multiple regression analysis to test the impact of person-centred care on employee performance. We adopted the STROBE guidelines. RESULTS: Friendly environment level and personalised care, respectively, scored the highest with a mean of 4.19 among five dimensions of person-centred care. Personalised care, residents' self-realisation and relationships, and organisational support had significant positive correlations with job productivity. Friendly environment level and organisational support had significant correlations with job satisfaction. Friendly environment level, residents' self-realisation and relationships, and organisational support had significant correlations with organisational commitment. CONCLUSION: Person-centred care has beneficial impact on job satisfaction, job productivity and organisational commitment of employees in long-term care facilities. RELEVANCE TO CLINICAL PRACTICE: Person-centred care appears to be a crucial factor of employee performance in long-term care facilities. The five-dimensional person-centred care questionnaire in this study can serve as an important management tool for improving the effectiveness of person-centred care.


Asunto(s)
Satisfacción en el Trabajo , Cuidados a Largo Plazo/normas , Atención Dirigida al Paciente/normas , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Encuestas y Cuestionarios , Taiwán
18.
Pediatrics ; 146(2)2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32430441

RESUMEN

To control the spread of severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019, many hospitals have strict visitor restriction policies. These policies often prohibit both parents from visiting at the same time or having grandparents or other family members visit at all. We discuss cases in which such policies created ethical dilemmas and possibly called for compassionate exceptions from the general rules.


Asunto(s)
Betacoronavirus , Niño Hospitalizado/psicología , Infecciones por Coronavirus/prevención & control , Control de Infecciones/métodos , Pandemias/prevención & control , Atención Dirigida al Paciente/ética , Neumonía Viral/prevención & control , Visitas a Pacientes/psicología , Adolescente , Niño , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/transmisión , Análisis Costo-Beneficio , Familia , Femenino , Política de Salud , Humanos , Recién Nacido , Control de Infecciones/normas , Masculino , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Neumonía Viral/psicología , Neumonía Viral/transmisión
19.
BMC Health Serv Res ; 20(1): 317, 2020 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-32299424

RESUMEN

BACKGROUND: Transitional care for older chronically ill people is an important area for healthcare quality improvement. A central goal is to involve older people more in transitional care and make care more patient-centered. Recently, asking, "What matters to you?" (WMTY) has become a popular way of approaching the implementation of patient-centered care. The aim of this study was to explore health care providers' perceptions and experiences regarding the question of WMTY in the context of improving transitional care for older, chronically ill persons. METHODS: The data comprise semi-structured individual interviews with 20 health care providers (HCPs) who took part in a Norwegian quality improvement collaborative, three key informant interviews, and observations of meetings in the quality improvement collaborative. We used a thematic analysis approach. RESULTS: Three interrelated themes emerged from the analysis: WMTY is a complex process that needs to be framed competently; framing WMTY as a functional approach; and framing WMTY as a relational approach. There was a tension between the functional and the relational approach. This tension seemed to be based in different understandings of the purpose of asking the WMTY question and the responsibility that comes with asking it. CONCLUSIONS: WMTY may appear as a simple question, but using it in everyday practice is a complex process, which requires professional competence. When seen in terms of a patient-centered goal process, the challenge of competently eliciting older people's personal goals and transferring these goals into professional action becomes evident. An important factor seems to be how HCPs regard the limits of their responsibility in relation to giving care within the larger frame of the patient's life project. Factors in the organizational and political context also seem to influence substantially how HCPs approach older patients with the WMTY question.


Asunto(s)
Participación del Paciente , Atención Dirigida al Paciente , Cuidado de Transición , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Personal de Salud , Humanos , Entrevistas como Asunto , Noruega , Atención Dirigida al Paciente/normas , Mejoramiento de la Calidad , Calidad de la Atención de Salud
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