Evaluation of a Patient Decision Aid for Refractive Eye Surgery.

BACKGROUND: We developed a prototype patient decision aid, EyeChoose, to assist college-aged students in selecting a refractive surgery. EyeChoose can educate patients on refractive errors and surgeries, generate evidence-based recommendations based on a user's medical history and personal preferences, and refer patients to local refractive surgeons. OBJECTIVES: We conducted an evaluative study on EyeChoose to assess the alignment of surgical modality recommendations with a user's medical history and personal preferences, and to examine the tool's usefulness and usability. METHODS: We designed a mixed methods study on EyeChoose through simulations of test cases to provide a quantitative measure of the customized recommendations, an online survey to evaluate the usefulness and usability, and a focus group interview to obtain an in-depth understanding of user experience and feedback. RESULTS: We used stratified random sampling to generate 245 test cases. Simulated execution indicated EyeChoose's recommendations aligned with the reference standard in 243 (99%). A survey of 55 participants with 16 questions on usefulness, usability, and general impression showed that 14 questions recorded more than 80% positive responses. A follow-up focus group with 10 participants confirmed EyeChoose's useful features of patient education, decision assistance, surgeon referral, as well as good usability with multimedia resources, visual comparison among the surgical modalities, and the overall aesthetically pleasing design. Potential areas for improvement included offering nuances in soliciting user preferences, providing additional details on pricing, effectiveness, and reversibility of surgeries, expanding the function of surgeon referral, and fixing specific usability issues. CONCLUSION: The initial evaluation of EyeChoose suggests that it could provide effective patient education, generate appropriate recommendations, connect to local refractive surgeons, and demonstrate good system usability in a test environment. Future research is required to enhance the system functions, fully implement and evaluate the tool in naturalistic settings, and examine the findings' generalizability to other populations.

Building a community of experts in medication-assisted treatment (MAT) using the Project ECHO© model.

BACKGROUND: Project Extension for Community Healthcare Outcomes (ECHO) utilizes telemedicine to connect a multidisciplinary team of experts with a -network of primary care physicians to enable rapid dissemination of evidence-based -guidelines and practices at scale. In this study, the Project ECHO model disseminated the Arizona Pain and Addiction Curriculum to providers in rural Arizona with the goal to educate providers on medication-assisted treatment (MAT). METHODS: Participants engaged in biweekly, virtual teleECHO sessions, and post-session surveys were used to collect data on provider satisfaction, self-efficacy, knowledge, barriers to change, and changes in practice behavior. RESULTS: Between February 2020 and November 2020, the MAT-ECHO program hosted 20 teleECHO sessions (N = 20) with 255 unique participating providers and delivered 877 learning hours. Analysis of a 6-month post-ECHO survey (N = 13) demonstrated that teleECHO sessions had broad geographic outreach. Participants had an average of 12 years of experience, 38 percent held NP/PA professional degrees, and 54 percent practiced in opioid treatment program settings. Assessment of job satisfaction and well-being revealed overall improved satisfaction among the small cohort of nonwaivered respondents (N = 8), except for meeting patient's needs. MAT-waivered respondents reported no post-session changes. CONCLUSIONS: Data from this study demonstrated that teleECHO sessions were well attended, consisted of a diverse cohort with various degrees, and had broad geographic outreach; hence, the utilization of the teleECHO model has the potential to reach rural providers and subsequently increase the availability and -efficacy of MAT in rural America.

Exploring the role of telehealth in providing equitable healthcare to the vulnerable patient population during COVID-19.

The COVID 19 pandemic resulted in widespread telehealth implementation. Existent health disparities were widened, with under-represented minorities (URM) disproportionately affected by COVID. In this study, we assess the role of telehealth in improving access to care in the URMs and vulnerable populations. We noted a statistically significant increase in the number of visits in Hispanic or Latino patients (15.2% increase, p < 0.01) and Black patients (19% increase, p < 0.01). Based on payer type, there was a statistically significant increase in the number of visits in the Medicare (10.2%, p = 0.0001) and Medicaid (16.2%, p < 0.01) groups. We also noted increased access to care with telehealth in patients who were 65 and older (10.6%, p = 0.004). This highlights the importance of telehealth in increasing access to care and promoting health equity in the URM and vulnerable patient populations.

Development of a Patient Decision Aid for Refractive Eye Surgery.

To address the needs of patient decision aid for refractive eye surgery, we developed a web-based tool, EyeChoose, which provides patient education, assists in selection of a specific surgical modality, generates customized recommendations, and links patients to local surgeons, targeting specifically the population of college students. We conducted a focus group interview for needs assessment. We designed a scoring algorithm to provide customized recommendation of surgical modalities based on a patient's medical history and personal preferences. We completed a prototype implementation of the tool. Initial data from a validation study indicated that the system achieved 99.18% accuracy in its recommendation. A study to examine the usefulness and usability of EyeChoose is ongoing. Future research is required to implement the tool in naturalistic settings and to examine the generalizability of the findings to other populations.

Opioid use disorder and COVID-19: Implications for policy and practice.

ABSTRACT: Preliminary data suggest that opioid-related overdose deaths have increased subsequent to COVID-19. Despite national support for expanding the role of physician assistants (PAs) and NPs in serving patients with opioid use disorder, these clinicians are held to complex and stringent regulatory barriers. COVID-19 triggered significant changes from regulatory and federal agencies, yet disparate policies and regulations persist between physicians and PAs and NPs. The dual epidemics of COVID-19 and opioid use disorder highlight the inadequate infrastructure required to support patients, communities, and clinicians, and may serve as the catalyst for eliminating barriers to care.

Burnout, job satisfaction, and stress levels of PAs.

OBJECTIVE: The main goal of this study was to assess burnout, job satisfaction, and stress to gain insight into the work lives of female and male PAs. METHODS: Data were obtained from the 2016 American Academy of PAs salary survey. Descriptive statistics were used to assess questions related to burnout, happiness, and stress and to compare responses by sex. RESULTS: Analysis revealed that, in general, PAs experience modest levels of burnout but are happy at work. More than half (55.6%) rated spending too many hours at work as an important contributor to stress. A higher percentage of female PAs than male PAs (32.2% versus 25.6%) have quit a job due to stress. CONCLUSIONS: Overall, PAs rate aspects of work life favorably. Further research on factors that contribute to the PA work experience may help inform interventions aimed at improving job satisfaction among healthcare professionals.

Women, family medicine, and career choice: An opportunity cost analysis.

OBJECTIVE: This study compared the cost of physician versus physician assistant (PA) education for women practicing in family medicine. METHODS: Using 2013 salary survey data from both the Medical Group Management Association and the American Academy of PAs as well as other publicly available data sources, the authors compared the current net present value (NPV) of physician and PA training for women practicing in family medicine. RESULTS: Considering a base case scenario involving a 24-year-old woman, the NPV to become a family medicine physician was $2,015,000 compared with an NPV of $1,751,000 to become a family medicine PA. Alternative projections produced an NPV for PA training that slightly exceeded the NPV for family medicine physician training. CONCLUSIONS: For a woman practicing in family medicine, becoming a physician or a PA offers similar financial rewards.

An Innovative Program in the Science of Health Care Delivery: Workforce Diversity in the Business of Health.

According to the most recent statistics from the National Center for Education Statistics, disparities in enrollment in undergraduate and graduate education are significant and not improving commensurate with the national population. Similarly, only 12% of graduating medical students and 13% of graduating physician assistant students are from underrepresented racial and ethnic groups. Established in 2012 to promote health care transformation at the organization and system levels, the School for the Science of Health Care Delivery is aligned with the university and college missions to create innovative, interdisciplinary curricula that meet the needs of our diverse patient and community populations. Three-year enrollment trends in the program exceed most national benchmarks, particularly among students who identify as Hispanic and American Indian/Alaska Native. The Science of Health Care Delivery program provides students a seamless learning experience that prepares them to be solutions-oriented leaders proficient in the business of health care, change management, innovation, and data-driven decision making. Defined as the study and design of systems, processes, leadership and management used to optimize health care delivery and health for all, the Science of Health Care Delivery will prepare the next generation of creative, diverse, pioneering leaders in health care.

Compensation and Production in Family Medicine by Practice Ownership.

The increasing focus on high performance, patient-centered, team-based care calls for a strategy to evaluate cost-effective primary care. The trend toward physician practice consolidation further challenges the primary care health care system. Productivity measures establish provider value and help inform decision making regarding resource allocation in this evolving health care system. In this national survey of family medicine practices, physician assistant (PA) productivity, as defined by mean annual patient encounters, exceeds that of both nurse practitioners (NPs) and physicians in physician-owned practices and of NPs in hospital or integrated delivery system-owned practices. Total compensation, defined as salary, bonus, incentives, and honoraria for physicians, is significantly more compared to both PAs and NPs, regardless of practice ownership or productivity. Physician assistants and NPs earn equivalent compensation, regardless of practice ownership or productivity. Not only do these data support the value and role of PAs and NPs on the primary care team but also highlight differences in patient encounters between practice settings. Rural and underserved community practices, where physician-owned practices persist, also merit further consideration. Further research is needed to inform both organizational and policy decisions for the provision of high-quality, cost-effective, and accessible primary health care.

Liver transplantation in a critically ill patient.

The United Network for Organ Sharing recently changed its policies for liver allocation to give patients with severe hepatic failure priority due to their greater risk of morbidity and mortality. This case illustrates the benefit of transplant in critically ill patients.

Ethics, equity, and economics: a primer on women in medicine.

Women account for more than 70% of physician assistant (PA) students, 62% of practicing PAs, and 57% of faculty in PA programs. About half of all US medical students, 30% of actively practicing physicians, and 37% of faculty at academic medical centers are female. However, women in medicine are paid less than men for equal work effort and achieve fewer leadership positions within academia and medicine. Neglecting the skills and talents of women may lead to a workforce that fails to represent our patient and student populations.

Basic skills workshop for physician assistant educators: effects of participation on perceived mastery of teaching skills and job satisfaction.

PURPOSE: The study examined participation in the Basic Skills Faculty Development Workshops (BSW) offered by the Physician Assistant Education Association (PAEA). The aim was to determine the effects of participation on perceived mastery of teaching skills and job satisfaction. METHODS: The 1,290 faculty and program director members of PAEA were invited to complete an electronic survey regarding their past participation in a BSW, levels of satisfaction with various aspects of their work, and their perception of their level of mastery of various teaching skills. Additionally, those who had participated in these workshops completed a section on colleague relationships that were developed or strengthened through workshop participation. RESULTS: Approximately half (n = 248) of the 493 respondents had participated in a BSW. Mean scores for satisfaction with salary, rank, position, and overall satisfaction did not differ significantly according to BSW participation. Perceived mastery of various teaching skills was significantly higher for nonattendees of BSW. However, controlling for "years in physician assistant education" nullified that association. Attendees reported a mean of 1.02 (SD = 1.47) new mentoring relationships and 2.45 (SD = 2.97) new peer relationships. Satisfaction with current position was significantly positively correlated with the number of colleague relationships. The number of new and strengthened mentor relationships correlated significantly with perceived mastery of advising students. CONCLUSIONS: Basic Skills Workshop attendees experience acceleration in their perceived mastery of teaching skills, closing the proficiency gap between them and their more-experienced colleagues who did not attend a Basic Skills Workshop. Also, participation is associated with an increased number of colleague relationships, which has a positive effect on satisfaction.

Salary discrepancies between practicing male and female physician assistants.

BACKGROUND: Salary discrepancies between male and female physicians are well documented; however, gender-based salary differences among clinically practicing physician assistants (PAs) have not been studied since 1992 (Willis, 1992). Therefore, the objectives of the current study are to evaluate the presence of salary discrepancies between clinically practicing male and female PAs and to analyze the effect of gender on income and practice characteristics. METHODS: Using data from the 2009 American Academy of Physician Assistants' (AAPA) Annual Census Survey, we evaluated the salaries of PAs across multiple specialties. Differences between men and women were compared for practice characteristics (specialty, experience, etc) and salary (total pay, base pay, on-call pay, etc) in orthopedic surgery, emergency medicine, and family practice. FINDINGS: Men reported working more years as a PA in their current specialty, working more hours per month on-call, providing more direct care to patients, and more funding available from their employers for professional development (p < .001, all comparisons). In addition, men reported a higher total income, base pay, overtime pay, administrative pay, on-call pay, and incentive pay based on productivity and performance (p < .001, all comparisons). Multivariate analysis of covariance and analysis of variance revealed that men reported higher total income (p < .0001) and base pay (p = .001) in orthopedic surgery, higher total income (p = .011) and base pay (p = .005) in emergency medicine, and higher base pay in family practice (p < .001), independent of clinical experience or workload. CONCLUSION: These results suggest that certain salary discrepancies remain between employed male and female PAs regardless of specialty, experience, or other practice characteristics.