Bridging the care continuum: patient information needs for specialist referrals.

BACKGROUND: Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians. METHODS: Structured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a specialist for the first visit for a chronic condition within the prior six months. The sample was selected from the patients who visited specialist physicians at any of the 500 hospitals from the National Research Corporation client base. RESULTS: Most patients (85%) received a good explanation about the reason for the specialist visit from the referring physician yet 26% felt unprepared about what to expect. Trust in the referring physician was highly associated with the preparatory information patients received. Specialists gave good explanations about diagnosis and treatment, but 26% of patients got no information about follow-up. Trust in the specialist correlated highly with good explanations of diagnosis, treatment, and self-management. CONCLUSION: Preparatory information from referring physicians influences the quality of the referral process, the subsequent coordination of care, and trust in the physician. Changes in the health care system can improve the information transfer process and improve coordination of care for patients.

The use of photovoice as a method of facilitating deliberation.

Efforts have been made in one rural Appalachian county to broaden local participation in a community health assessment. Through a series of community forums and a photovoice project, residents named community health needs and assets, framed potential solutions, and selected possible action steps to improve the local health status. Photographs and narratives from the photovoice project supplemented information from preliminary health forums to devise a framework of possible solutions to the identified health problems. Analysis of forum transcripts suggests that participants who used an issue guide that used photovoice images and stories were able to transition from broad approaches of change to specific action steps more than participants in other forums who used a more traditional forum issue guide. Community members are more easily able to identify solutions to local health issues when forum discussions are informed by local images and narratives.

A statewide assessment of e-HIT use by all healthcare providers.

Knowledge of capacity and use of health information technology is essential in developing a secure interoperable statewide electronic health network. The purpose of this research was to conduct a comprehensive state-wide assessment of multiple healthcare providers and translate the data through geospatial mapping into a model to guide the development of RHIOs and HIEs. This research reflects the most comprehensive e-Health adoption survey to date for state healthcare decision makers in the extant literature.

Defining elements of success: a critical pathway of coalition development.

In recent decades, coalitions have been established to address many public health problems, including injury prevention. A partnership among the Kentucky Injury Prevention and Research Center and four injury prevention coalitions has documented the developmental stages of successful coalitions. This developmental process was constructed through the analysis of participating coalition documents, such as each coalition's mission statement, bylaws or rules of operation, the use of committees within the organization, frequency of meetings, and additional historical documents. Themes from this analysis guided researchers in designing a critical pathway model that describes milestones in coalition formation. Critical components in coalition formation include a clear definition of the coalition structure, coalition enhancement, funding, community support, leadership, education and outreach to the community, membership, partnerships, data and evaluation, and publicity. These findings are applicable to public health professionals who work with community-based coalitions and citizens who participate in local coalitions.

Patient safety in after-hours telephone medicine.

OBJECTIVES: This study analyzed our family medicine department's after-hours telephone medicine systems at an academic health center from a patient safety perspective. The research questions were (1) What are the threats to patient safety associated with after-hours telephone medicine and (2) What kinds of errors are made during after-hours telephone medicine? METHODS: Subjects were patients at the University of Kentucky family medicine practice who called in to the after-hours answering service. Telephone interviews were conducted with 64 patients over 10 weeks. During the interviews, patients described their telephone medicine experience, identified any problems, and reported potential or actual harm (patient-identified threats to patient safety). Two registered nurses and one physician analyzed the patient narratives to identify threats to patient safety (medical personnel-identified threats to patient safety). RESULTS: Sixty-three analyzable patient interviews identified four instances (6%) of temporary physical harm. Two separate after-hours calls (3%) involved four medical errors with potentially serious consequences to patient safety (wrong dose, serious illness not ruled out). Fourteen calls (22%) involved events that could have threatened patient safety. CONCLUSIONS: Situations that threaten patient safety occur frequently in telephone medicine. Although this study is too small to draw strong conclusions, it suggests that there are risks to patient safety associated with after-hours telephone medicine.

The public and public health organizations: issues for community engagement in public health.

Deliberative processes are beginning to take effect in the public health sector. Public health organizations have a critical role in fostering local deliberation during the planning and implementation of community health efforts. The chief executive officer (CEO) of eight national public health constituent organizations were provided background readings about deliberation and its potential role in community public health planning. They were then interviewed about their prior knowledge of public health deliberation, impressions and thoughts about deliberation's role in public health, whether they could identify constituents using the approach, and the best method of disseminating information on deliberation. Information provided by stakeholders was analyzed to gauge the understanding and implementation of public deliberation. Four main themes emerged from the interviews including: general awareness and attitudes about public deliberation, barriers to deliberation, words of caution when using the deliberative approach, and dissemination of deliberation. Each of the CEOs interviewed favored deliberative approaches in public health planning that would ensure that the community's voice is present in the decision-making process. However, there are certain limitations to the approach that must be addressed before the full benefits of public engagement can be obtained in public health.

Increasing awareness of health care resources for the uninsured and underinsured:a pilot study.

Programs are available to provide assistance to the uninsured, but information about how to access those programs is not readily available to the average uninsured citizen. A pilot study involving the University of Kentucky Family and Consumer Science Agents and Homemaker groups in two rural counties significantly increased the number of people who accessed one of the programs, Health Kentucky. Findings from the study could be validated in other Kentucky counties and with other types of health-related messages.

Child advocacy outreach: using telehealth to expand child sexual abuse services in rural Kentucky.

We evaluated the use of videoconferencing as an educational and consultative tool for physicians and mental health staff providing services for child victims of sexual abuse in rural Kentucky. The number of counties with access to sexual abuse examinations by a qualified physician increased from 16 to 23 in the first year and to 54 in the second. The number of cases increased from 77 to 83 in the first year and to 339 in the second year. The number of consultations increased from zero to eight in the first year and to 74 in the second year. A user survey showed that the equipment supported clinical decision making, was useful and was easy to use. However, it was not as effective for case conferencing as for one-to-one interactions. Rural health professionals knowledge of child sexual abuse increased.